Exploratory analysis of the neutrophil to lymphocyte ratio in patients with pulmonary arterial hypertension

Abstract

BackgroundChronic inflammation emerges as a feature of the pathogenesis of pulmonary arterial hypertension (PAH) in experimental models. Alterations of circulating cell subsets have been observed in patients with PAH. We aimed to assess associations of the white blood cell count with disease severity and outcome in patients with PAH.MethodsThe total and differential white blood cell count was related to functional parameters, pulmonary hemodynamics and transplantation-free survival in 77 patients with PAH in an observational single center study.ResultsAn increased neutrophil/lymphocyte ratio was associated with poor World Health Organization functional class and shorter 6-minute walking distance, as well as with elevated right atrial pressure and high level of N-terminal prohormone of brain natriuretic peptide. During a median follow-up period of 31 months (range 16-56) 23 patients died and 2 patients were referred to lung transplantation. Using uni- and subsequent bivariate Cox proportional hazards analyses an increased neutrophil/lymphocyte ratio was associated with unfavorable transplantation-free survival independent of hemodynamic parameters and C-reactive protein. The prognostic implication sustained in subsets of patients with incident PAH and in the absence of cardiovascular risk factors.ConclusionsThe results of this analysis indicate that a neutrophilic inflammation may be associated with clinical deterioration and poor outcome in patients with PAH. Assessing the composition of the differential white blood cell count may render prognostic information and could represent a step towards incorporating an inflammatory marker into the clinical management of patients with PAH.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0407-5) contains supplementary material, which is available to authorized users.

Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: An Immunological Perspective

“…Besides their phagocytic role, neutrophils are able to degranulate and release antimicrobial contents. In PAH patients, an increased neutrophil-to-lymphocyte ratio in peripheral blood samples positively correlates with the NYHA FC and a negative ratio can even predict event-free survival [45,46]. In CTEPH patients, the neutrophil-to-lymphocyte ratio could predict postoperative mortality and might be used as a noninvasive measuring tool for operative risk stratification [47].…”

Hubungan rasio netrofil limfosit dengan hipertensi arteri pulmonal pada anak dengan penyakit jantung bawaan asianotik

“…Hasil ini sedikit lebih tinggi dibandingkan hasil penelitian HAP pada pasien dewasa dengan nilai cutoff point 1,65 dengan sensitivitas 72% dan spesifitas 69%. 8 Dengan demikian, RNL dapat dijadikan sebagai prediktor adanya HAP dengan keunggulan murah, mudah, dan praktis untuk digunakan.…”

“…7 Beberapa penelitian menyata kan bahwa RNL dapat digunakan untuk menilai berat nya penyakit atau keluaran penyakit pada pasien dengan hipertensi arteri pulmonal. 7,8 Penelitian tentang RNL sebagai diagnosis dilakukan oleh Yildiz dkk 9 dengan hasil cut off point RNL 1,65 dengan sensitivitas 72% dan spesifitas 69%. 9 Rasio neutrofil limfosit sebagai biomarker prognosis didapatkan hubungan antara RNL dengan hasil/prognosis yang buruk pada pasien hipertensi arteri pulmonal.…”

“…9 Rasio neutrofil limfosit sebagai biomarker prognosis didapatkan hubungan antara RNL dengan hasil/prognosis yang buruk pada pasien hipertensi arteri pulmonal. 7,8 Penelitian-penelitian di atas masih terbatas pada pasien dewasa dengan HAP. Hubungan RNL pada pasien anak dengan HAPbelum banyak diteliti.…”

Identification of a novel HIF-1α-αMβ2Integrin-NETosis axis in fibrotic interstitial lung disease

“…HIF-1α is known to contribute to the pathology of pulmonary hypertension 65,66 , with some work specifically interrogating endothelial HIF signalling 67 . Neutrophilic inflammation has also been associated with pulmonary hypertension 68 , and believed to drive angiogenesis via NETosis 69 .…”