Neutrophil-to-lymphocyte ratio used as prognostic factor marker for dilated cardiomyopathy in childhood and adolescence

Abstract

Objective:The objective of this study is to evaluate the neutrophil-to-lymphocyte ratio (NLR) and platelet–lymphocyte ratio, from the hemograms obtained from children and adolescents with dilated cardiomyopathy (DCM), and to correlate them with the levels of B-type natriuretic peptide (BNP) and with the clinical evolution of these patients in the long term.Materials and Methods:Follow-up of 57 patients with DCM was made retrospectively, with hemogram and BNP level determination being performed after optimized therapy for heart failure. We compared the findings of the patients' examinations that progressed with stability in relation to the occurrence of transplant listing, cardiac transplantation, or evolution to death.Results:The average age was 48 months, and the follow-up was 64 months. The average of the levels of neutrophils was greater in poor evolution group (7026 vs. 3903; P = 0.011) as well as the average of NLR (5.5 vs. 1.9; P = 0.034). The averages of hemoglobin, total leukocytes, lymphocytes, and platelets were similar in the groups. The area under the receiver operating characteristic curve for NLR in relation to the poor evolution was of 72.9%, being the best cutoff point of NLR ≥5.2 (sensitivity: 93.8% and specificity: 87.8%). Kaplan–Meier curves demonstrate that patients with NLR ≤5.2 (P = 0.001) and BNP <1000 pg/dl (P < 0.0001) presented greater survival.Conclusions:NLR (≥5.2) and lymphopenia (≤1000 lymphocyte/μL) were associated with a poor prognosis and a higher chance of evolution to death or cardiac transplant, similar to the findings for BNP.

Well-Known and Novel Serum Biomarkers for Risk Stratification of Patients with Non-ischemic Dilated Cardiomyopathy

“…C-reactive protein is a nonspecific biomarker of inflammation and a well-known causative factor of endothelial dysfunction [ 11 ]. As observed in other chronic diseases, such as systemic arterial hypertension, diabetes, cancer or chronic kidney disease, the inflammatory process is also observed in heart failure [ 12 , 13 ]. Studies have shown that patients with chronic heart failure (CHF), regardless of the etiology, have elevated serum levels of hs-CRP [ 14 , 15 , 16 ].…”

“…Additionally, patients with heart failure and elevated white blood cell count, neutrophilia and lymphocytopenia, have an increased mortality [ 22 , 23 ]. The neutrophil to lymphocyte ratio has recently emerged as a new inflammatory biomarker that can be used in the staging prognosis of several chronic diseases [ 12 , 24 ]. Thus, in the last few years, NLR has been shown to be an eligible biomarker associated with the severity of chronic heart failure in children, adolescents [ 12 ] and adults with dilated cardiomyopathy [ 22 ].…”

“…The neutrophil to lymphocyte ratio has recently emerged as a new inflammatory biomarker that can be used in the staging prognosis of several chronic diseases [ 12 , 24 ]. Thus, in the last few years, NLR has been shown to be an eligible biomarker associated with the severity of chronic heart failure in children, adolescents [ 12 ] and adults with dilated cardiomyopathy [ 22 ]. Avci and coworkers prospectively evaluated 87 patients with idiopathic dilated cardiomyopathy, in order to assess whether NLR levels are associated with echocardiographic parameters, New York Heart Association functional class or B-type natriuretic peptide (BNP) values.…”

“…Another recent study evaluated the correlation between NLR and BNP levels and chronic heart failure severity, in children and adolescents with dilated cardiomyopathy. They included 57 patients, with an average age of 48 months, and after a follow-up period of 64 months, concluded that NLR levels are associated with a poor prognosis and a higher risk of death or cardiac transplant [ 12 ]. The results of these studies, even though they are few and with a relatively small number of patients, demonstrated that NLR is a noninvasive and available biomarker that may be used to assess the severity of heart failure in patients with dilated cardiomyopathy, but unfortunately, its importance has not been studied specifically in patients with NIDCM.…”

The effect of systemic inflammation markers on predicting pregnancy results in patients admitted to emergency department with threatened miscarriage

“…10,11 Bu iki belirtecin akut ve kronik inflamasyon ile ilişkili jinekolojik, gastrointestinal ve kardiyak patolojileri içeren birçok durumda faydalı olduğu gösterilmiştir. [12][13][14][15] Bu çalışmanın amacı, bahsedilen bu yeni iki belirtecin inflamatuar sürecin önemli rol oynadığı düşünülen AI olgularında tanısal değerlerini incelemek ve gebelik sonuçlarını öngörmedeki yerini araştırmaktır.…”