Differential leukocyte counts and cardiovascular mortality in very old patients with acute myocardial infarction: a Chinese cohort study

Abstract

Background Total leukocyte and differential Leukocyte counts are prognostic indictors in patients with coronary artery disease (CAD). However, there is no data available regarding their prognostic utility in very old patients with acute myocardial infarction (AMI). The aim of this study is to investigate the potential role of different leukocyte parameters in predicting the mortality among very old patients with AMI. Methods A total of 523 patients aged over 80 years with AMI were consecutively enrolled into this study. Leukocyte and its subtypes were obtained at admission in each patient. The primary study endpoint was cardiovascular mortality. Patients were followed up for an average of 2.2 years and 153 patients died. The associations of leukocyte parameters with mortality were assessed using Cox regression analyses. The concordance index was calculated to test the model efficiency. Results In multivariable regression analysis, neutrophils-plus-monocytes-to-lymphocytes ratio (NMLR) and neutrophils-to-lymphocytes ratio (NLR) were two most significant predictors of mortality among all the leukocyte parameters (HR = 3.21, 95% CI 1.75–5.35; HR = 2.79, 95% CI 1.59–4.88, respectively, all p < 0.001, adjusted for age, male gender, body mass index, family history of CAD, smoking, hypertension, diabetes mellitus, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, high sensitivity C-reactive protein, creatinine, left ventricular ejection fraction, troponin I, use of statin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and percutaneous coronary intervention). Furthermore, adding NMLR and NLR into the Cox model increased the C-statistic by 0.038 and 0.037 respectively, which were more significant than that of other leukocyte parameters. Besides, addition of NMLR and NLR to the Canada Acute Coronary Syndrome Risk Score model also increased the C-statistic by 0.079 and 0.077 respectively. Conclusion Our data firstly indicated that most leukocyte subtypes were independent markers for the mortality in very old patients with AMI, while NMLR and NLR appeared to be more effective.

The neutrophil-lymphocyte ratio to predict poor prognosis of critical acute myocardial infarction patients

“…Previous studies have suggested that advanced age, chronic kidney disease, and HF are related to inflammatory response status and associated with higher mortality of AMI patients ( 31 , 32 ). Yan et al found that NLR was a potential independent marker of mortality in elderly patients with AMI, which was consistent with our subgroup analysis ( 33 ). Physicians need to be vigilant in AMI patients with high- and very high-NLR, especially those with advanced age, higher SCr and WBC concentrations, HF, and those without reperfusion therapy.…”

Predictive value of neutrophil to lymphocyte ratio and red cell distribution width on death for ST segment elevation myocardial infarction

“…In elderly patients with AMI, NLR is significantly and independently related to mortality, and has better predictive power than other leukocyte parameters. Moreover, adding NLR to traditional risk models, including age, hypertension, diabetes and other risk factors, also significantly improves the efficiency of the model 21 . Recent studies have found that in acute coronary syndromes, the NLR value is related to the prognosis of ACS.…”

The Admission (Neutrophil+Monocyte)/Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Patients With Acute Myocardial Infarction

“…For instance, in newly diagnosed multiple myeloma patients who received bortezomib+cyclophosphamide+dexamethasone regimen therapy, Pang et al ( 7 ) found that the high NMLR group experienced a lower median progression-free survival than the low NMLR group. In addition, in very old patients (>80 years old) with AMI, Yan et al ( 8 ) suggested that NMLR appeared to be an independent marker for long-term cardiovascular mortality.…”

“…As an emerging indicator of inflammatory and immune status, NMLR is the ratio of the sum of peripheral neutrophil and monocyte counts to peripheral lymphocyte counts. Although a few previous studies have suggested that NMLR is a prognostic indicator for diseases related to inflammatory and immune disorders ( 7 , 8 ), evidence supporting the association between admission NMLR and in-hospital mortality in AMI remains scarce. Given that NMLR integrates different acute-phase inflammatory and immune responses and may comprehensively reflect the balance between damage and repair in AMI, we hypothesized that admission NMLR might represent a powerful predictor for in-hospital mortality in AMI.…”