Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome

Abstract

Objective:Platelets and inflammatory cells are vital elements of acute coronary syndromes (ACS). Recent studies have shown that the plateletto-lymphocyte ratio (PLR) is associated with several malignancies; however, there are not enough data in cardiovascular diseases. Therefore, the aim of this study was to explore the association between PLR and in-hospital mortality in patients with ACS.Methods:We retrospectively collected patients with ACS undergoing coronary angiography. Total and differential leukocyte counts were measured by an automated hematology analyzer.Results:This study is single-centered and observational. In total, 587 patients with a mean age of 61.8±13.1 years (68.4% male) were enrolled in the study. Patients were divided into 3 tertiles based on PLR levels. In-hospital mortality was significantly higher among patients in the upper PLR tertile when compared with the middle and lower PLR tertile groups [29 (14.8%) vs. 17 (8.7%) and 2 (1.0%); p<0.001]. In the multiple logistic regression analysis, a high level of PLR was an independent predictor of in-hospital mortality, together with age, total leukocyte count, and creatinine. Using a cutoff point of 142, the PLR predicted in-hospital mortality with a sensitivity of 69% and specificity of 63%.Conclusion:Different from other inflammatory markers and assays, PLR is an inexpensive and readily available biomarker that may be useful for cardiac risk stratification in patients with ACS.

Correlations between hematological indicators and other known markers in acute coronary syndromes

“…(4) Instead of examining neutrophils and lymphocytes separately, NLR has been shown to be more prognostic.…”

“…(4) The platelet count is associated with the underlying inflammation because inflammatory mediators stimulate megakaryocytic proliferation and result in a prothrombotic state with relative thrombocytosis. (4,5) As platelet levels increase, more platelet rich thrombosis is observed in atherosclerotic plaques, and antiplatelet therapy response is reduced. (4) It is known that platelets are associated with endothelial activation as well as inflammatory functions.…”

“…(10) In many inflammatory conditions neutrophils are stimulated to release many cytokines and cytotoxic or proteolytic enzymes. (4) These enzymes have adverse effects on the ischemic heart by damaging endothelial cells, stimulating the coagulation system, blocking the microvascular circulation, and increasing infarct expansion. (4) Lymphocytes, as parts of the adaptive immunity system, fight against inflammation and suppress inflammation.…”

“…(2) Recently, many studies have been published, which demonstrate that hematological markers measured in peripheral blood count such as platelet, neutrophil, lymphocyte are predictors in the diagnosis and the determination of the prognosis of acute coronary syndromes (ACS). (3,4) Increased platelet activation has been reported to play a role in the onset and the progression of atherosclerosis. (5) It has been reported that increased platelet count is associated with platelet activation and may be associated with thrombotic tendency and major adverse cardiac events.…”

Platelet-to-lymphocyte ratio: a prognostic factor for patients with advanced hepatocellular carcinoma?

“…PLR has been recently suggested to be a marker of thrombotic and inflammatory condition. In the literature, it was shown that valvular heart diseases, acute coronary syndromes, hypertension, end-stage renal diseases, and other diseases may potentially affect the PLR [2][3][4][5][6]. In the study of Xing Li et al [1], patients with previous and/or secondary cancers were excluded, while such as heart diseases which is very common in old people (age 57 (19-86)) were not mentioned.…”