Platelet-to-lymphocyte ratio is a marker of poor prognosis in patients with diabetes mellitus and ST-elevation myocardial infarction

Predictive value of platelet-related hematological markers in indicating the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM)

BACKGROUND

The predictive value of hematological markers in the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM) remains to be investigated. We aim to evaluate the role of platelet-related parameters after laparoscopic IPOM in patients with incisional hernias.

METHODS

The data of 95 patients who underwent laparoscopic IPOM for appendicectomy-related incisional hernias were retrospectively analyzed. The complete blood count analyses were measured preoperatively, and the outcomes were obtained from hospital records and follow-up calls to patients. Platelet-multiple-lymphocyte index (PLM), neutrophil-leukocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) values were calculated. The patients were grouped based on the recurrence and the postoperative complications after surgery.

RESULTS

Using cutoff values acquired by the Youden Index, we found platelet levels < 212.0 × 1000/μl, NLR > 2.33, LMR < 3.17, and PLM < 365.5 were revealed to be statistically significant in the recurrence of hernias based on univariant or multivariant analysis (p =  < 0.05). We further divided the patients into two groups based on the cutoff value of PLM and found that a PLM value < 365.5 was significantly associated with the recurrence of incisional hernia (p = 0.018), the occurrence of postoperative seroma (p = 0.044), and there is a tendency that patients with PLM < 365.5 may suffer from other postoperative complications such as cardiopathy, respiratory infection, and hypoproteinemia (p = 0.089).

CONCLUSION

The preoperative hematological values, especially PLM, may indicate the outcomes in incisional hernias after laparoscopic IPOM.

Efficacy of low-fat milk and yogurt fortified with vitamin D3 on systemic inflammation in adults with abdominal obesity

Background

The prevalence of vitamin D deficiency is increasing globally and is associated with an increased risk of metabolic syndrome, autoimmune disease, and cardiovascular disease. Vit D deficiency is also associated with increased systemic inflammation. The current study aimed to determine the efficacy of low-fat milk and yogurt fortified with 1500 IU nano-encapsulated vitamin D, on systemic inflammation in abdominal obese participants.

Method

This multi-center study was conducted using a 2.5-month parallel total-blind randomized clinical trial design. Two hundred and eighty nine subjects were allocated to four groups: low-fat milk fortified by 1500 IU nano-encapsulated vitamin D₃ (200 mL/day). Simple milk (200 mL/day), low-fat yogurt fortified by 1500 IU nano-encapsulated vitamin D₃ (150 g/day), and simple yogurt (150 g/day).

Results

The results showed that serum levels of neutrophils, lymphocytes, platelets and red blood cell distribution width (RDW) were significantly lower before and after the intervention in fortified dairy groups. The results showed that serum levels of neutrophils, lymphocytes, platelets, and RDW before and after intervention in the fortified dairy groups were significantly lower (p < 0.05). The values of = neutrophil to lymphocyte ratio (NLR), platelets to lymphocyte ratio, and RDW to platelets ratio (RPR) reduced significantly in the fortification group (p < 0.05).

Conclusion

Fortification with nano-encapsulated vitamin D₃ of dairy products may decrease inflammation in individuals with abdominal obesity.

Platelet-to-Lymphocyte Ratio Predicts the Presence of Diabetic Neurogenic Bladder

PURPOSE

Diabetic neurogenic bladder (DNB) has been widely recognized in recent years. It is common in patients with long-term diabetes and may also lead to many severe complications. Although there has been widespread evidence that inflammation is involved in the development of some diabetic complications, there is little evidence that this can also occur in the bladder. In recent years, platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) have been viewed as potential novel markers of inflammatory responses. This study was designed to evaluate the relationship between the presence of DNB and the PLR and NLR.

PATIENTS AND METHODS

A total of 371 cases of T2DM patients were included in this retrospective study. Patients were divided into two groups, with 115 diabetic subjects diagnosed with diabetic neurogenic bladder and 256 control subjects without DNB. The independent predictors of DNB were analyzed using logistic regression.

RESULTS

Compared with patients without DNB, the mean PLR and NLR were significantly higher in those with DNB (p < 0.001). Based on the logistic regression, PLR was found to be an independent risk factor for DNB (odds ratio [OR]: 1.408, 95% confidence interval [CI]: 1.248-1.617). From the receiver operating characteristic (ROC) curve, using PLR as indicative of DNB was expected to be 101.1949, and it generated a sensitivity and specificity value of 89.6% and 23.4%, respectively. The area under the curve (AUC) was also found to be 0.899 (95% CI: 0.865-0.932).

CONCLUSION

In our study, PLR and NLR were significantly higher for patients with DNB. The PLR was found to be a risk factor in the presence of DNB after correcting for possible confounding factors. Considering the severe complications associated with DNB, patients with elevated PLR should be seriously cared for in clinics.

Do platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) have a predictive value on pediatric extracorporeal membrane oxygenation (ECMO) results?

BACKGROUND

It is difficult to predict the complications and prognosis of ECMO, which is gaining widespread use in patients with pediatric surgery. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are emerging inflammatory markers that can be calculated from complete blood count, which is a cheap and easily accessible laboratory analysis. The ratios between cellular elements in peripheral blood have been demonstrated to provide information on inflammation, infection, and immune response.

METHODS

Sixty-seven patients who needed ECMO application after undergoing pediatric cardiovascular surgery in our clinic, between May 2005 and April 2020, were included in this study. The age of patients varied between 4 days and 17 years with a mean of 30.59 ± 147.26 months.

RESULTS

The relationships between PLR or NLR values and various blood parameters and blood gas results were found to be statistically nonsignificant in our group of pediatric ECMO recipients. Even if the effect of PLR and NLR values on mortality and prognosis is statistically nonsignificant in patients who need ECMO after congenital heart surgery, PLR and NLR are typically elevated in the postoperative period. An increase in these values above a certain threshold may be a statistically significant indicator for the prediction of mortality.

CONCLUSIONS

There are few studies in the literature concerning PLR and NLR values in patients with pediatric heart surgery. We consider this study will make way for new studies in the future.

Platelet-to-lymphocyte ratio and prognosis in STEMI: A meta-analysis

BACKGROUND

Platelet-to-lymphocyte ratio (PLR) is a haematological index which reflects increased level of inflammation and thrombosis. We aimed to summarize the potential prognostic role of PLR for the in-hospital and long-term outcomes in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI) in a meta-analysis.

MATERIALS AND METHODS

Relevant cohort studies were identified by search the PubMed, Cochrane's Library and Embase databases. A random-effect model was applied to pool the results. In-hospital and long-term outcomes were compared between patients with higher and lower preprocedural PLR.

RESULTS

Eleven cohorts with 12 619 patients were included. Pooled results showed that higher preprocedural PLR was independently associated with increased risk of in-hospital major adverse cardiovascular events (MACE, risk ratio [RR]: 1.76, 95% confidence interval [CI]: 1.39 to 2.22, P < .001; I²  = 49%), cardiac mortality (RR: 1.91, 95% CI: 1.18 to 3.09, P = .009; I²  = 0), all-cause mortality (RR: 2.14, 95% CI: 1.52 to 3.01, P < .001, I²  = 24%) and no reflow after pPCI (RR: 2.22, 95% CI: 1.70 to 2.90, P < .001, I²  = 59%). Moreover, higher preprocedural PLR was associated with increased risk of MACE (RR: 1.60, 95% CI: 1.25 to 2.03, I²  = 57%, P < .001) and all-cause mortality (RR: 2.36, 95% CI: 1.53 to 3.66, I²  = 78%, P < .001) during long-term follow-up of up to 82 months after discharge.

CONCLUSIONS

Higher PLR predicts poor in-hospital and long-term prognosis in STEMI patients after pPCI.

Platelet-to-Lymphocyte Ratio at Admission as a Predictor of In-Hospital and Long-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Background

ST-segment elevation myocardial infarction (STEMI) is the most severe form of acute coronary syndrome (ACS) which is associated with significant adverse outcomes. Platelet-to-lymphocyte ratio (PLR) is a novel inflammatory biomarker that has been used as a predictor of various cardiovascular diseases, including ACS. This meta-analysis aimed to investigate the prognostic value of PLR as a predictor of in-hospital and long-term outcomes in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods

We performed a comprehensive systematic literature search in the databases of PubMed, ScienceDirect, Cochrane Library, and ProQuest for eligible studies. The primary outcomes were major adverse cardiac events (MACEs) and mortality, both in-hospital and long-term follow-up. The outcomes were compared between patients with high and low admission PLR. The quality assessment was conducted using the Newcastle-Ottawa scale. Review Manager 5.3 was used to perform the meta-analysis.

Results

Six cohort studies involving 4,289 STEMI patients undergoing primary PCI were included in this meta-analysis. The pooled analysis showed that a high PLR at admission was associated with increased in-hospital MACE (odds ratio (OR) = 1.94, 95% confidence interval (CI) = 1.56 - 2.40, P < 0.00001, I² = 45%) and in-hospital mortality (OR = 2.07; 95% CI = 1.53 - 2.80; P < 0.00001; I² = 50%), as well as increased long-term MACE (OR = 1.98; 95% CI = 1.31 - 3.00; P = 0.001; I² = 72%) and long-term mortality (OR = 2.79; 95% CI = 1.45 - 5.36; P = 0.002; I² = 83%).

Conclusions

In patients with STEMI undergoing primary PCI, a high PLR at admission predicts in-hospital MACE and mortality along with long-term MACE and mortality.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict Mortality in Patients with Diabetic Foot Ulcers Undergoing Amputations

PURPOSE

Elevated platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with poor outcomes in various diseases. The objectives of this study were to explore the utility of PLR and NLR in predicting all-cause mortality in patients with diabetic foot ulcers (DFU) undergoing amputations.

PATIENTS AND METHODS

A retrospective observational study was performed that included a total of 348 DFU patients undergoing amputations. The primary end-point was all-cause death. According to the PLR and NLR cut-off values, patients were divided into two groups and Kaplan-Meier survival curves were constructed. Multivariable Cox regression was conducted to test the independent predictors of mortality in the study cohort.

RESULTS

All-cause mortality was significantly higher in patients with a high PLR/NLR compared to those with a low PLR/NLR. In the low NLR group, the overall survival (OS) rates at 1, 3, and 5 years after amputation were 96.8%, 84% and 80.1%, respectively (p=0.001). In the high NLR group the corresponding OS rates at 1, 3, and 5 years were 85.2%, 58.6% and 23.9% (p<0.001). According to the multivariate analysis, age (HR 1.074, 95% CI 1.045-1.104, p<0.001), Wagner classification (HR 2.274, 95% CI 1.351-3.828, p=0.002), PLR (HR 1.794, 95% CI 1.014-3.174, p=0.045), NLR (HR 2.029, 95% CI 1.177-3.499, p=0.011), creatinine (HR 1.003, 95% CI 1.001-1.004, p<0.001) and direct bilirubin (HR 1.154, 95% CI 1.081-1.232, p<0.001) were independent predictors of mortality following amputation.

CONCLUSION

Postoperative PLR and NLR values may be reliable predictive biomarkers of mortality in patients following amputation for DFU. Considering the high mortality in those patients, the patients with elevated PLR/NLR should be given more intensive in clinical practice.

CAN COMPLETE BLOOD CELL COUNT PARAMETERS PREDICT DEEP VEIN THROMBOSIS?

The aim of this study was to evaluate complete blood cell count parameters including red blood cell indices, white blood cell subtypes, and platelet indices for predicting deep vein thrombosis (DVT). A total of 71 (44 male and 27 female) patients with acute femoral and popliteal DVT diagnosed by doppler ultrasonography during a period of seven years (2011-2017) were included in the study. By matching age and gender, 142 (88 male and 54 female) subjects diagnosed with venous insufficiency in the same time interval were assigned as control group. Data were obtained by reviewing hospital records of the study participants, including clinical and demographic characteristics and complete blood cell parameters. Frequencies of hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal failure, and coronary arterial disease were higher in DVT group as compared to non-DVT group (p<0.05). Hemoglobin and lymphocyte values were lower, and red blood cell distribution width, neutrophil, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio higher in DVT group as compared with non-DVT group (p<0.05). There was no significant between-group difference in terms of mean corpuscular volume, platelet, mean platelet volume, mean platelet volume to platelet ratio, and platelet distribution width (p>0.05). Hypertension, hemoglobin, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. We found that hypertension, anemia, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. In particular, neutrophil to lymphocyte ratio and hemoglobin may be used as novel, inexpensive, and reliable diagnostic tools for DVT.

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Biomarkers for Cardiovascular Surgery Procedures: A Literature Review

BACKGROUND

Neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have been studied so far as prognostic factors of cardiovascular diseases. Their role interplayed with endothelial inflammation has emerged as optimal predictors for major cardiovascular disease events and prognostic factors for post-procedural outcomes.

METHODS

A review of the current literature was undertaken to investigate the relationship between NLR and PLR with percutaneous, cardiac surgery, and vascular surgery procedures.

RESULTS

Our findings show that perioperative NLR and PLR levels are significantly correlated with patient morbidity and mortality rates.

CONCLUSION

These biomarkers have several attractive characteristics, as they are inexpensive and quickly available, and they can contribute to the early identification of patients at high risk for periprocedural adverse events.

Adipocytokine expression, platelet-to-lymphocyte ratio and TGF-1/Smad signaling activity in diabetic patients complicated with pulmonary infection

OBJECTIVE

To investigate adipocytokine expression levels, platelet-to-lymphocyte ratio (PLR) and transforming growth factor (TGF)-β1/Smad signaling activity in diabetic patients with pulmonary infection.

METHODS

Eighty-two type 2 diabetic patients with pulmonary infection were included in the observation group and 75 patients with simple type 2 diabetes were recruited into the control group. The fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and PLR in the two groups were compared. Complement-C1q/tumor necrosis factor related protein 3 (CTRP-3), complement-C1q/tumor necrosis factor related protein 9 (CTRP-9), leptin, adiponectin, and TGF-β1/Smad signaling pathway activity in peripheral blood mononuclear cells (PBMCs) was detected.

RESULTS

Compared with patients in the control group, patients in the observation group presented with increased levels of FGB, HbA1c, and leptin, an increase in the PLR, and decreased serum CTRP-3, CTRP-9, and adiponectin levels. TGF-β1, p-Smad2, and p-Smad3 protein expression levels were up-regulated in PBMCs from patients in the observation group compared with the control group.

CONCLUSIONS

These results show that in type 2 diabetic patients with pulmonary infection, adipocytokine expression is altered, PLR is disturbed, and the TGF-β1/Smad signaling pathways in PBMCs are significantly activated.

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19 Patients and Control Group and Relationship with Disease Prognosis

BACKGROUND

The present study aimed to compare the complete blood count (CBC) indices between COVID-19 patients and the control group, and assess the relationship of these indices with COVID-19 prognosis.

METHODS

COVID-19 patients (confirmed by PCR or CT-Scan) who visited Imam Hospital in Sari were selected in this case-control study. The control group was selected from Tabari cohort population matched with the case group in terms of gender and age. CBC, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and outcome of the disease (in the case group) were assessed in this study.

RESULTS

The number of participants were 527 in both case and control groups, of which, 232 (44%) were females in each arms. Platelet count, lymphocyte count, and hemoglobin concentration were also higher in the control group (P=0.000). NLR and PLR were significantly higher in COVID-19 patients compared to the control group (P=0.000). NLR had a significant relationship with the severity of the disease. NLR was two times higher in the patients who died of COVID-19 than those who recovered (P=0.000). ROC curve analysis for diagnostic values of NLR and PLR showed that the areas under the ROC curves for NLR and PLR were 0.703 (95% CI: 0.64-0.76) and 0.535 (95% CI: 0.46-06), respectively.

CONCLUSION

NLR can be used as a prognostic marker for COVID-19 given the significant difference of NLR between those who died and recovered from COVID-19.

Platelet-to-Lymphocyte Ratio (PLR) Is Associated with Immune Thrombocytopenia (ITP) Recurrence: A Retrospective Cohort Study

BACKGROUND Current guidelines are inadequate for use in predicting ITP recurrence. Therefore, our primary goal in this study was to investigate the association of platelet-to-lymphocyte ratio (PLR) at diagnosis with ITP recurrence in Chinese patients. MATERIAL AND METHODS We performed a historical cohort study and non-selectively enrolled 233 patients with newly-identified ITP from March 2013 to June 2017. The independent variable was PLR recorded at diagnosis and the dependent variable was recurrence-free survival (RFS) at 6 months. Data on the following variables were also collected for establishing a multivariate Cox regression model: demographic details, general details, and variables found to be closely related to PLR in previous studies, as well as risk factors for ITP recurrence. RESULTS During follow-up, 85 patients had an event within 6 months. At the range of 0.86-9.7 of PLR, a 1-unit increase in PLR was associated with a 13% decrease in ITP recurrence (hazard ratio: 0.87; 95% confidence interval: 0.78-0.97), whereas no association was detected at the range of 9.7-33.75 of PLR (hazard ratio: 0.99; 95% confidence interval: 0.95-1.04). An interaction test indicated that patients with HP infection (0.91 (0.86-1.97)) or diabetes history (0.86 (0.78-0.96)) showed a stronger association compared with patients without HP infection (1.01 (0.95-1.04) and those without diabetes (1.01 (0.97-1.04)). CONCLUSIONS Our findings suggest that PLR is a useful parameter to consider when hematologists attempt to assess the risk of recurrence in ITP patients receiving first-line therapy, and the nonlinearity of PLR and ITP recurrence risk must be fully considered when constructing predictive models.

[Value of red blood cell distribution width-to-platelet count ratio in predicting the prognosis of children with sepsis]

OBJECTIVE

To study the value of red blood cell distribution width (RDW)-to-platelet count (PLT) ratio (RPR) on the first day of admission into the pediatric intensive care unit (PICU) in predicting the prognosis of children with sepsis.

METHODS

A retrospective analysis was performed for the clinical data of 186 children with sepsis who were hospitalized in the PICU. According to their prognosis, they were divided into a survival group with 151 children and a death group with 35 children. Clinical data were compared between the two groups. The Cox proportional-hazards regression model analysis was used to investigate the factors influencing the prognosis. The receiver operating characteristic (ROC) curve was plotted to evaluate the value of RPR in predicting death. The children were divided into a high RPR group and a low RPR group according to the optimal cut-off value, and the Kaplan-Meier method was used to compare the 28-day survival rate between the two groups.

RESULTS

Compared with the survival group, the death group had significantly higher RDW, procalcitonin (PCT) and RPR (P<0.05) and significantly lower PLT and albumin (ALB) (P<0.05). The Cox regression model analysis showed that low ALB, high PCT and high RPR were independent risk factors for the prognosis of children with sepsis (P<0.05). The ROC curve analysis showed that RPR had a certain value in predicting the prognosis of children with sepsis (P<0.05), with an area under the ROC curve of 0.937, an optimal cut-off value of 0.062, a sensitivity of 94.29%, and a specificity of 77.48%. The Kaplan-Meier survival analysis showed that the high RPR group had a significantly lower 28-day survival rate than the low RPR group (P<0.05).

CONCLUSIONS

RPR on the first day of admission into the PICU is closely associated with the prognosis of children with sepsis and has an important value in predicting the prognosis of children with sepsis.

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as independent predictors of outcome in infective endocarditis (IE)

Background

Early and accurate risk assessment is an important clinical demand in patients with infective endocarditis (IE). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are independent predictors of prognosis in many infectious and cardiovascular diseases. Very limited studies have been conducted to evaluate the prognostic role of these markers in IE.

Results

We analyzed clinical, laboratory, and echocardiographic data and outcomes throughout the whole period of hospitalization for a total of 142 consecutive patients with definitive IE.

The overall in-hospital mortality was 21%. Major complications defined as central nervous system embolization, fulminant sepsis, acute heart failure, acute renal failure, and major artery embolization occurred in 38 (27%), 34 (24%), 32 (22.5%), 40 (28%), and 90 (63.4%) patients, respectively.

The NLR, total leucocyte count (TLC), neutrophil percentage, creatinine, and C-reactive protein (CRP) level obtained upon admission were significantly higher in the mortality group [p ≤ 0.001, p = 0.008, p = 0.001, p = 0.004, and p = 0.036, respectively].

A higher NLR was significantly associated with fulminant sepsis and major arterial embolization [p = 0.001 and p = 0.028, respectively].

The receiver operating characteristic (ROC) curve of the NLR for predicting in-hospital mortality showed that an NLR > 8.085 had a 60% sensitivity and an 84.8% specificity for an association with in-hospital mortality [area under the curve = 0.729, 95% confidence interval (CI) 0.616–0.841; p = 0.001]. The ROC curve of the NLR for predicting severe sepsis showed that an NLR > 5.035 had a 71.8% sensitivity and a 68.5% specificity for predicting severe sepsis [area under the curve 0.685, 95% CI 0.582–0.733; p = 0.001].

The PLR showed no significant association with in-hospital mortality or in-hospital complications.

Conclusion

A higher NLR, TLC, neutrophil percentage, creatinine level, and CRP level upon admission were associated with increased in-hospital mortality and morbidity in IE patients. Furthermore, a lower lymphocyte count/percentage and platelet count were strong indicators of in-hospital mortality among IE patients.

Calculation of the NLR directly from a CBC upon admission may assist in early risk stratification of patients with IE.

Pretreatment neutrophil-to-lymphocyte ratio predicts prognosis in patients with diabetic macular edema treated with ranibizumab

Background

To investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with diabetic macular edema (DME) treated monthly with ranibizumab.

Methods

We retrospectively analyzed the medical records of all patients who received intravitreal ranibizumab (IVR) treatment for DME at the First Affiliated Hospital of Nanchang University between December 2015 and December 2017. Clinicopathological parameters, including NLR, were evaluated to identify predictors of better outcomes of IVR monotherapy.

Results

Ninety-one treatment-naïve eyes treated with IVR for DME were retrospectively analyzed in this study. Baseline best-corrected visual acuity (BCVA), neutrophils, NLR, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were negatively correlated with the changes in BCVA at 24 weeks compared with the baseline, while baseline central retinal thickness and lymphocytes were positively correlated with the changes in BCVA at 24 weeks compared with the baseline. Multiple linear regression analysis revealed that NLR was independently associated with the mean change of BCVA between baseline and week 24. In addition, patients with NLR < 2.27 showed a better improvement in letter score than those with NLR > 2.27.

Conclusion

Pretreatment NLR is independently associated with the BCVA in DME patients treated with IVR, and higher pretreatment NLR may contribute to inferior BCVA outcomes.

The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study

Identification of rapid, inexpensive, and reliable prognostic factors can improve survival estimation and guide healthcare in patients with acute heart failure (AHF). In this study, we aimed to determine the prognostic value of the platelet-to-lymphocyte ratio (PLR) in patients with AHF. A total of 443 patients from two hospitals met the inclusion criteria from January 2010 to December 2017. Univariate and multivariate Cox analyses were performed to determine the association of PLR with survival. All-cause mortality was analysed using the Kaplan-Meier method. The 6-month survival rate for patients according to PLR quartiles (<110.63, 110.63-139.23, 139.23-177.17, and >177.17) were 90.09%, 76.79%, 50.07%, and 37.27%, respectively (p < 0.001). Univariate analysis identified high PLR (>110.63), old age (≥73 years), smoking habit, low estimated glomerular filtration rate (<57), and high platelet count (≥198 × 10⁹/l) as poor prognostic factors for survival. In the multivariate analysis, after adjusting for confounding factors, the third (hazard ratio [HR] = 3.118, 95% confidence interval [CI] = 1.668-5.386, p < 0.001) and fourth (HR = 2.437, 95% CI = 1.302-3.653, p < 0.001) quartiles of PLR were identified as independent prognostic factors in patients with AHF. A higher PLR was associated with poor clinical outcomes in patients with AHF and might be a novel marker in AHF management.

Platelet to Lymphocyte Ratio in Cardiovascular Diseases: A Systematic Review

The platelet to lymphocyte ratio (PLR) is an integrated reflection of 2 opposite thrombotic/inflammatory pathways that are easily calculated from a complete blood count. The PLR initially served as a systemic inflammatory biomarker to predict the prognosis of neoplastic diseases. In recent years, the PLR has been used as a prognostic marker in cardiovascular (CV) conditions. In this review, we consider the evidence regarding the association of the PLR with CV disease (CVD) and its possible use as a prognostic marker of CVD. The role of PLR has been investigated in CV conditions in several studies. We assessed clinical trials using PubMed, EMBASE, and Web of Science (up to April 18, 2018) to evaluate the association between PLR and mortality/major adverse cardiac events in these conditions. Most of these studies reported significant relationships between a high PLR and diverse outcomes. In conclusion, we suggest that PLR is a cheap and easily available systemic inflammatory marker that can predict distinct outcomes in different types of CVD.

The relationship of blood cell-associated inflammatory indices and diabetic retinopathy: a Meta-analysis and systematic review

AIM

To explore the correlation between several blood cell-associated inflammatory indices including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and the presence and severity of diabetic retinopathy (DR).

METHODS

We searched for eligible studies from PubMed, EMBASE, Web of Science and CNKI up to December 13, 2017. Standardized mean difference (SMD) calculated with confidence interval (CI) of 95% was used to estimate the values of those indices.

RESULTS

A total of 31 studies were included in the present Meta-analysis. As compared with type 2 diabetes mellitus (T2DM) patients without DR, the values of MPV, PDW, NLR, and PLR were higher in patients with DR (SMD=0.67; 95%CI: 0.36 to 0.98; SMD=0.51; 95%CI: 0.27 to 0.75; SMD=0.77; 95%CI: 0.49 to 1.05 and SMD=1.18; 95%CI: 0.07 to 2.28). Additionally, it was also observed that MPV was closely correlated with the severity of DR.

CONCLUSION

MPV, PDW, NLR, and PLR could be recommended as diagnostic biomarkers for DR, and MPV could be applied to assess the severity of DR.

Usefulness of Platelet-to-Lymphocyte Ratio to Predict Long-Term All-Cause Mortality in Patients at High Risk of Coronary Artery Disease Who Underwent Coronary Angiography

Platelet-to-lymphocyte ratio (PLR) has recently been studied as a biomarker in patients with established coronary artery disease (CAD). The association between PLR and long-term all-cause mortality is unclear in patients at high risk of CAD who undergo coronary angiography for various indications. Follow-up was completed for 514 patients who underwent coronary angiography in a prospective study cohort. The primary end point was all-cause mortality. Patients were classified into tertiles based on preangiography PLR and also dichotomized based on the optimal cutoff at a PLR of 137, determined from the receiver operating characteristic curve analysis. The mean follow-up period was 5.0 ± 1.3 years, with 50 all-cause deaths. On the Kaplan-Meier analysis, patients in Tertile 3 (PLR > 145) had worse prognosis than patients in Tertiles 1 (PLR ≤ 106) and 2 (PLR 106.1 to 145) (p = 0.0075), and patients with PLR ≥ 137 had a significantly higher rate of all-cause mortality than those with PLR < 137 (p = 0.0006). On multivariate Cox regression adjusting for known cardiovascular risk factors, PLR was a strong, independent predictor of long-term all-cause mortality on the tertile analysis (Tertile 3 vs Tertile 1: hazard ratio 2.52, 95% confidence interval 1.18 to 5.39, p = 0.017) and based on the cutoff at a PLR of 137 (PLR ≥ 137 vs <137: hazard ratio 2.25, 95% confidence interval 1.21 to 4.20, p = 0.011). In conclusion, elevated PLR is associated with long-term all-cause mortality in patients at high risk of CAD who undergo coronary angiography, and PLR may be a useful prognostic biomarker in this population.

Platelet Metabolism and Other Targeted Drugs; Potential Impact on Immunotherapy

The role of platelets in cancer progression has been well recognized in the field of cancer biology. Emerging studies are elaborating further the additional roles and added extent that platelets play in promoting tumorigenesis. Platelets release factors that support tumor growth and also form heterotypic aggregates with tumor cells, which can provide an immune-evasive advantage. Their most critical role may be the inhibition of immune cell function that can negatively impact the body’s ability in preventing tumor establishment and growth. This review summarizes the importance of platelets in tumor progression, therapeutic response, survival, and finally the notion of immunotherapy modulation being likely to benefit from the inclusion of platelet inhibitors.

Association between multimorbidity and mean platelet volume in diabetic patients with acute myocardial infarction

AIMS

Diabetes mellitus (DM) is one of the most frequently detected conditions in multimorbid disease clusters. Platelet activation is one of the key mechanisms underlying atherothrombosis in acute myocardial infarction. Available data link mean platelet volume (MPV) to poor prognosis not only in cardiovascular and non-cardiovascular disease. Given the lack of research data on the association between disease clusters and MPV, we have set out to investigate the link between multimorbidity and MPV in diabetic patients with acute myocardial infarction.

METHODS

A total of 277 patients with DM and STEMI undergoing primary percutaneous coronary intervention were enrolled. Based on the number of comorbidities the study population was divided into two groups: group 1 (N = 58) with ≤ 1 comorbidity and group 2 (N = 219) with ≥ 2 comorbidities. A subanalysis was performed within the multimorbidity group: group 2A with two or three comorbidities (N = 156) and group 2B with at least four comorbidities (N = 63).

RESULTS

In the study population, 15.9% of patients had one comorbidity, and 22.0, 34.3, and 22.7% of patients had two, three, or at least four comorbid conditions, respectively. Both MPV and PDW were elevated in multimorbid patients (9.3 vs 10.8 fl and 9.5 vs 10.3 fl, respectively). The highest platelet volume indices were observed in patients with at least four comorbid conditions. There was a moderate positive correlation between MPV and the total number of comorbidities, the number of CVD comorbidities, and the number of non-CVD comorbidities.

CONCLUSIONS

These findings indicate that multimorbidity is associated with an increase in platelet volume indices. MPV values increased with the increasing number of comorbid conditions. Importantly, MPV values were elevated in some, but not all CVD and non-CVD conditions.

Platelet-to-lymphocyte ratio predicts contrast-induced acute kidney injury in diabetic patients with ST-elevation myocardial infarction

AIM

There has been a rise in contrast-induced acute kidney injury (CI-AKI). We examined the role of platelet-to-lymphocyte ratio (PLR) in predicting CI-AKI episodes in patients with myocardial infarction (MI) and diabetes.

METHODS

A total of 719 patients with diabetes and MI were enrolled. Study population was divided into: group 1 (n = 615) without CI-AKI and group 2 (n = 104) with CI-AKI.

RESULTS

Patients with CI-AKI had higher in-hospital mortality and a longer in-hospital stay. Median PLR was higher in patients with CI-AKI. Receiver operating characteristic analysis indicated PLR to be a good predictive tool in assessing the risk of CI-AKI. PLR was an independent predictor of CI-AKI (OR: 1.22; p < 0.0001).

CONCLUSION

These results suggest potential role for PLR as a biomarker of CI-AKI among diabetic patients with MI who undergo percutaneous coronary intervention.

Relationship Between Plasma Pentraxin 3 Concentration and Platelet Indices in Patients With Stable Coronary Artery Disease

Few reports have analyzed the effect of pentraxin 3 (PTX3) on platelets and their activation. We explored the association between plasma PTX3 and platelet indices. Forty-nine patients with stable coronary artery disease (CAD) were enrolled. Based on median PTX3, the study population was divided into group 1 (n = 25; PTX3 ≤ 0.98 ng/mL) and group 2 (n = 24; PTX3 > 0.98 ng/mL). Platelet indices investigated included mean platelet volume (MPV), platelet distribution width (PDW), platelets and large cell ratio (P-LCR), MPV to platelet count ratio (MPV/PC), platelet to lymphocyte ratio (PLR), and MPV to lymphocyte ratio (MPVLR). Patients with lower PTX3 had a higher lymphocyte count. Platelet count was similar in both groups. Notwithstanding, patients with higher PTX3 concentrations had elevated MPV (8.3 vs 10.0 fL; P < .001) and PDW (9.4 vs 12.4 fL; P < .001). However, the MPV/PC ratio was similar in both groups. Thromboinflammatory biomarkers (PLR, MPVLR) were also elevated in group 2. Pentraxin 3showed a strong, positive correlation with MPV ( r = .75, P < .01) and PDW ( r = .80, P < .01), and weak to moderate correlation with MPVLR. In conclusion, PTX3 is associated with larger platelet size as assessed by platelet volume indices. There is a strong correlation between plasma PTX3 level and MPV and PDW.

Platelet to lymphocyte ratio in the prediction of adverse outcomes after acute coronary syndrome: a meta-analysis

Recent studies have shown platelet to lymphocyte ratio (PLR) to be a potential inflammatory marker in cardiovascular diseases. We performed a meta-analysis to systematically evaluate the prognostic role of PLR in acute coronary syndrome (ACS). A comprehensive literature search up to May 18, 2016 was conducted from PUBMED, EMBASE and Web of science to identify related studies. The risk ratio (RR) with 95% confidence interval (CI) was extracted or calculated for effect estimates. Totally ten studies involving 8932 patients diagnosed with ACS were included in our research. We demonstrated that patients with higher PLR level had significantly higher risk of in-hospital adverse outcomes (RR = 2.24, 95%CI = 1.81–2.77) and long-term adverse outcomes (RR = 2.32, 95%CI = 1.64–3.28). Sensitivity analyses confirmed the stability of our results. We didn’t detect significant publication bias by Begg’s and Egger’s test (p > 0.05). In conclusion, our meta-analysis revealed that PLR is promising biomarker in predicting worse prognosis in ACS patients. The results should be validated by future large-scale, standard investigations.

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as predictors of wound healing failure in head and neck reconstruction

CONCLUSIONS

In microsurgical head and neck reconstruction, a higher rate of post-operative wound complication could be predicted by a lower pre-operative neutrophil ratio (< 64.9%), neutrophil-lymphocyte ratio (NLR) (< 3.5), and platelet-lymphocyte ratio (PLR) (< 160).

OBJECTIVES

To evaluate the predictor of post-operative wound complications in microsurgical head and neck reconstruction.

METHODS

Patients who were undergoing tumor ablation and microsurgical reconstruction from April 2011 to March 2014 were analyzed retrospectively. The pre-operative hematological data, age, sex, co-morbidities, body mass index (BMI), adjuvant therapies, smoking, operation time, blood loss, total protein, T-stage, and Anesthesiologists Performance Status (ASA-PS) score were collected. Cases of post-operative wound healing failure were reviewed.

RESULTS

One hundred and three consecutive patients were enrolled. Among these, the results of 77 patients who were younger than 70 years of age were analyzed. The distributions of the neutrophil ratio (p = .0005), lymphocyte ratio (p = .0166), monocyte ratio (p = .0341), NLR (p = .005), and PLR (p = .008) differed significantly between the patients with and without post-operative wound healing failure. Neutrophil ratio, NLR, and PLR cut-off values of 64.9, 3.5, and 160 were significantly associated with the rate of wound healing failure rate (p = .0002, .00021, .0042, respectively).

Platelet-to-lymphocyte ratio as a novel marker of in-hospital and long-term adverse outcomes among patients with acute pulmonary embolism: A single center large-scale study

BACKGROUND

The interaction of platelets with leukocytes is a well-known process both in progression and prognosis of acute pulmonary embolism (PE). Recently, platelet to lymphocyte ratio (PLR) is emerged as an indirect inflammatory indicator which was shown to be associated with adverse cardiovascular events in various clinical conditions, including acute PE. However, the long-term prognostic value of PLR in acute PE has not been investigated thoroughly. Therefore, we aimed to assess the impact of PLR on both in-hospital and long-term adverse outcomes in acute PE.

METHODS

A total of 459 patients with definite diagnosis of acute PE between January 2009 and January 2016 were enrolled. On admission, blood sampling to calculate PLR and detailed clinical data were obtained. Patients were divided into tertiles according to the admission PLR levels. Simplified PE severity index (sPESI) score and computerized tomography (CT) based pulmonary artery obstruction index were calculated for each patient.

RESULTS

Mean sPESI score of the study population was 1.6. A total of 34 patients (7.4%) died during index hospitalization. At median 28.8months follow-up, all-cause mortality was observed in 81 patients (1.9%). Patients in the highest tertile of PLR revealed a higher rate of in-hospital adverse events including cardiogenic shock, the necessity for thrombolytic therapy and in-hospital mortality as well as long-term all-cause mortality. In multivariate analysis, the PLR was found to be a significant predictor of both in-hospital adverse events (OR: 1.588, 95% CI:1.116-2.154, p=0.004) and long-term all-cause mortality (OR:1.746, 95% CI:1.211-2.865, p=0.001).

CONCLUSIONS

The PLR, as a simple, inexpensive and available marker of inflammatory and prothrombotic status, seemed to be a novel predictor of in-hospital and long-term adverse outcomes in patients with acute PE.

A novel simplified thrombo-inflammatory score portends poor outcome in diabetic patients following myocardial infarction

AIM

We investigated prognostic value of novel simplified thrombo-inflammatory score (sTIPS) in patients with ST-elevation myocardial infarction (STEMI) and diabetes mellitus.

METHODS

A total of 465 patients with diabetes mellitus and STEMI were included in the study. Based on admission cut-off values for predicting in-hospital mortality of white blood cell count (>13.4 × 10³/mm³) and mean platelet volume-to-platelet count ratio (>0.06), the patients were assigned 0 point for having the lower value of each variable and 1 point for having the upper value of each variable. sTIPS was calculated as the sum of these two variables.

RESULTS

Kaplan-Meier curves demonstrated that higher sTIPS categories were associated with higher in-hospital and 12-month mortality. One-point increment in the score was associated with 51% increase in the risk of in-hospital death and 89% increase in the risk of long term.

CONCLUSION

sTIPS is useful in predicting worse immediate and long-term outcomes following STEMI.

Mean platelet volume-to-lymphocyte ratio: a novel marker of poor short- and long-term prognosis in patients with diabetes mellitus and acute myocardial infarction

INTRODUCTION

Platelet activation and hyperreactivity plays a pivotal role in developing intravascular thrombus in ST elevation myocardial infarction (STEMI). Mean platelet volume (MPV), which is readily available in clinical settings, has been linked to poor prognosis following STEMI. Recently, platelet-to-lymphocyte ratio (PLR) has emerged as a new marker of worse outcomes linking inflammation and thrombosis. We investigated the prognostic significance of the new marker, MPVLR, in diabetic patients with STEMI undergoing percutaneous coronary intervention (PCI).

METHODS

A total of 623 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled and divided based on the median MPVLR on admission into two groups: group 1 (N=266) with an MPVLR ≤4.46 and group 2 (N=257) with an MPVLR >4,46.

RESULTS

Despite similar clinical features patients with elevated MPVLR (group 2) had worse angiographic characteristic suggestive of a higher thrombus burden. In-hospital and one-year mortality was higher in group 2. ROC analysis revealed moderate diagnostic value in predicting in-hospital mortality (adjusted HR 1.13; 95% CI 1.04-1.23; P=0.003; MPVLR cut-off >6.13) similar to that of PLR a good diagnostic value in predicting long-term mortality (adjusted HR 1.52; 95% CI 1.42-1.63; P<0.0001; MPVLR cut-off >5.88) better than that of PLR. MPVLR remained an independent risk factor of early and late mortality.

CONCLUSIONS

To the best of our knowledge, this is the first ever study that has investigated MPVLR. Despite similar clinical characteristics, patients with elevated MPVLR had worse angiographic features which may indicate a greater thrombus burden. Elevated MPVLR is an independent risk factor of early and late mortality following STEMI. In addition, it has similar value to PLR in predicting in-hospital mortality, and a better value than PLR in predicting long-term mortality.

The association between platelet-to-lymphocyte ratio and inflammatory markers with the severity of aortic stenosis

AIM

Platelet-to-lymphocyte ratio (PLR) was proposed as a novel indirect marker of inflammation. We aimed to evaluate the relationship between PLR and aortic stenosis (AS).

PATIENTS & METHODS

The study population included 453 patients of which 98 patients with severe AS, 206 patients with mild-to-moderate AS and 149 patients as control.

RESULTS

PLR was significantly increased in parallel to the severity of AS (p < 0.001). There was significant positive correlation between PLR and maximum, and mean systolic transaortic gradient (all p < 0.001). Also, PLR was correlated with C-reactive protein and neutrophil-to-lymphocyte ratio (all p < 0.001) and PLR was independently associated with the presence of AS (p < 0.001).

CONCLUSION

We found a significant relationship between PLR and AS.

Comparison of the predictive value of plateletcrit with various other blood parameters in gestational diabetes development

Gestational diabetes is the most encountered metabolic disease in pregnancy and affects both the mother and fetus adversely. Low-grade subchronic inflammation is associated with gestational diabetes development. Platelets (PLT) play role in blood coagulation and inflammatory process. We aimed to compare the various platelet indices in patients with GDM and healthy pregnant controls and to determine whether PLT indices are useful in Gestational diabetes diagnosis. The present study was performed at the Zonguldak Bulent Ecevit University, School of Medicine, Department of Obstetrics and Gynecology. Statistically significant relationships with plateletcrit, mean platelet volume, and platelet distribution width and patients with GDM were found (p < 0.001). Plateletcrit had higher sensitivity and specificity than other platelet indices. Although plateletcrit is a largely unknown or an underestimated parameter in complete blood count, it gives more precise information than platelet count and mean platelet volume. Platelet-related indices and their determination are inexpensive and routinely ordered markers, the significance of which is often ignored. They may be useful in screening for gestational diabetes as an adjunct to oral glucose tolerance test.

Association between hematologic parameters and in-hospital mortality in patients with infective endocarditis

Early and accurate risk prediction is an important clinical demand in patients with infective endocarditis (IE). The platelet-to-lymphocyte ratio (PLR) is an independent predictor of worse prognosis in various cardiovascular diseases. The aim of this study was to determine the value of PLR in the prediction of in-hospital mortality among IE patients. We retrospectively analyzed the clinical, laboratory, and echocardiographic data of 59 adult patients with definite IE and in 40 adult controls. In-hospital mortality occurred in 16 (27%) patients. Vegetation size, levels of high-sensitive C-reactive protein and procalcitonin, neutrophil-to-lymphocyte ratio, and PLR were significantly higher in the in-hospital-mortality-positive group than in the in-hospital-mortality-negative group (p = 0.004, p = 0.009, p = 0.030, p = 0.001, and p = 0.008, respectively). Lymphocyte count was, however, significantly lower in the in-hospital-mortality-positive group (p = 0.004). In the receiver-operating characteristic analysis, PLRs over 191.01 predicted in-hospital mortality with 56.3% sensitivity and 81.4% specificity [area under the curve 0.725, 95% confidence interval (CI) 0.594-0.833; p = 0.0027]. In the multivariate analysis, PLR was found to be an independent predictor of in-hospital mortality in patients with IE (odds ratio 1.022, 95% CI 1.003-1.042; p = 0.021). In conclusion, higher PLR may predict in-hospital mortality in patients with IE.

The Prognostic Role of Red Blood Cell Distribution Width in Coronary Artery Disease: A Review of the Pathophysiology

Red blood cell distribution width (RDW) is a measure of red blood cell volume variations (anisocytosis) and is reported as part of a standard complete blood count. In recent years, numerous studies have noted the importance of RDW as a predictor of poor clinical outcomes in the settings of various diseases, including coronary artery disease (CAD). In this paper, we discuss the prognostic value of RDW in CAD and describe the pathophysiological connection between RDW and acute coronary syndrome. In our opinion, the negative prognostic effects of elevated RDW levels may be attributed to the adverse effects of independent risk factors such as inflammation, oxidative stress, and vitamin D₃ and iron deficiency on bone marrow function (erythropoiesis). Elevated RDW values may reflect the intensity of these phenomena and their unfavorable impacts on bone marrow erythropoiesis. Furthermore, decreased red blood cell deformability among patients with higher RDW values impairs blood flow through the microcirculation, resulting in the diminution of oxygen supply at the tissue level, particularly among patients suffering from myocardial infarction treated with urgent revascularization.

Use of the Monocyte-to-Lymphocyte Ratio to Predict Diabetic Retinopathy

Background: Diabetic retinopathy (DR) is a common complication of type 2 diabetes mellitus (T2DM) and the leading cause of blindness in adults. DR pathogenesis has not been fully elucidated, but inflammation is widely accepted to play an important role. Emerging evidence suggests that the platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) are novel potential markers of inflammatory responses. The present study aimed to evaluate the associations between DR and the PLR, MLR, and NLR. Patients and Methods: We performed a case-control study involving 247 patients with T2DM. The patients were divided into three groups: 125 control subjects with T2DM, 63 diabetic subjects with non-proliferative diabetic retinopathy (NPDR), and 59 patients with proliferative diabetic retinopathy (PDR). Results: The mean PLR and NLR were significantly higher in patients with DR compared with patients without DR (p < 0.01, p = 0.02, respectively). The mean MLR in the NPDR group was higher than that of patients without DR, but there were no significant differences among the three groups (p = 0.07). Logistic regression showed that the MLR was an independent risk factor for DR (odds ratio [OR]: 54.574, 95% confidence interval [CI]: 2.708–1099.907). Based on the receiver operating characteristic (ROC) curve, use of the MLR as an indicator for DR diagnosis was projected to be 2.25, and yielded a sensitivity and specificity of 47.1% and 69.6%, respectively, with an area under the curve of 0.581 (95% CI: 0.510–0.653). Conclusions: The PLR and NLR are significantly increased in the setting of DR. After correcting for possible confounding factors, the MLR was found to be a risk factor for DR. Although the MLR may be pathophysiologically and clinically relevant in DR, its predictive ability was limited.

Platelet to Lymphocyte Ratio as a Prognostic Marker of In-Hospital and Long-Term Major Adverse Cardiovascular Events in ST-Segment Elevation Myocardial Infarction

We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) on in-hospital and long-term major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in a large prospective study. Patients (n = 1938) admitted with acute STEMI within 12 hours of symptom onset and who underwent pPCI between January 2010 and January 2015 were followed up for 31.6 ± 16.2 months. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, nonfatal myocardial infarction, and mortality were higher in the third PLR tertile group. A PLR in the third tertile had 2.4-fold increased risk of in-hospital MACE and 2.8-fold risk of long-term MACE. The PLR was significantly and positively correlated with peak creatine kinase MB (CK-MB) levels (r = 0.562, P < .001) and Gensini score (r = 0.408, P < .001). Kaplan-Meier analysis of long-term MACE-free survival revealed a higher occurrence of MACE in the third PLR tertile group compared to the other tertiles. In conclusion, the PLR may be a marker of inflammatory and prothrombotic status and predicted in-hospital and long-term MACE in a population with STEMI.