Hematological Biomarkers of Troponin, Neutrophil-to-Lymphocyte Ratio, and Monocyte-toLymphocyte Ratio Serve as Effective Predictive Indicators of High-Risk Mortality in Acute

Abstract

Background Assessing high-risk mortality in acute coronary syndrome (ACS) patients, encompassing ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI), and Unstable Angina Pectoris (UAP), is crucial. However, the prognostic significance of hematological parameters in predicting high-risk mortality in ACS patients remains uncertain despite advancements in ACS research. Aim The aim was to investigate prognostic significance of hematological parameters troponin, Creatine Kinase-MB (CKMB), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocyte-to-Lymphocyte Ratio (MLR), Basophil-to-Lymphocyte Ratio (BLR), and Eosinophil-to-Lymphocyte Ratio (ELR) levels in predicting high-risk mortality in ACS patients. Methods In this retrospective observational study, data from medical records of 115 patients with ACS, including 40 with STEMI, 38 with NSTEMI, and 37 with UAP, were analyzed. Patients were selected using stratified random sampling, whereby five patients were randomly chosen each month from January 2021 to December 2022 while maintaining a 1:1:1 ratio of selection. Results Troponin (r = 0.519) and NLR (r = 0.484) showed moderate positive correlations with high-risk STEMI mortality. Meanwhile, troponin (r = 0.387), NLR (r = 0.279), PLR (r = 0.276), MLR (r = 0.250), BLR (r = 0.237), and ELR (r = −0.344) were found to be significantly correlated with high-risk ACS mortality. Troponin, CKMB, NLR, and MLR were significant (AUC>0.7) for high-risk STEMI mortality, and Troponin, NLR, and MLR were significant for high-risk ACS mortality. The results of the multivariate regression analysis indicated that only Troponin (OR:2.049; 95%CI: 1.802–8.218; p = 0.014), NLR (OR:1.652; 95%CI: 1.306–7.753; p = 0.030), and MLR (OR:4.067; 95%CI: 1.182–13.987; p = 0.026) were capable of predicting high-risk ACS mortality. Sub-group analysis showed an increased risk of ACS mortality by GRACE score >140 in patients with elevated levels of Troponin (OR:2.787; 95%CI: 1.032–7.524; p < 0.05), NLR (OR:3.287; 95%CI: 1.340–8.059; p < 0.05), and MLR (OR:4.156; 95%CI: 1.634–10.569; p < 0.05) above the cut-off value. Conclusion Troponin, NLR, and MLR levels above the cutoff independently predict high-risk mortality in ACS.

Role of leukocyte parameters in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with high thrombus burden

“…Leukocyte parameters, such as leukocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR), reflect the inflammatory status and are appreciated as inflammation markers that have been associated with acute coronary syndrome ( 6 , 7 ). NLR and MLR were found to have a slight positive correlation with high-risk STEMI mortality ( 8 ). The value of NLR and PLR on admission could predict the in-hospital major adverse cardiac events (MACEs) in patients with acute myocardial infarction ( 9 ).…”

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“…Leukocyte parameters, such as leukocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR), reflect the inflammatory status and are appreciated as inflammation markers that have been associated with acute coronary syndrome (6,7). NLR and MLR were found to have a slight positive correlation with high-risk STEMI mortality (8). The value of NLR and PLR on admission could predict the in-hospital major adverse cardiac events (MACEs) in patients with acute myocardial infarction (9).…”