Red Cell Distribution Width and Neutrophil Lymphocyte Ratio (Nlr) as Novel Marker in Coronary Artery Disease

Abstract

BACKGROUND Ischaemic Heart Disease (IHD) is one of the most common causes of death worldwide. There has been an increase in incidence of ischaemic heart disease in recent times particularly in the younger age groups with or without risk factors. Various parameters are used in different scoring systems to assess the risk of developing ischaemic heart disease. RDW and NLR are the two emerging parameters from the time Price-Jones C first described variation in RBC size, RDW has evolved as an easily available parameter after the invention of impedance haematology auto analysers. NLR is an inflammatory marker, which is superior to ESR and its level rises in ischaemic heart disease. RDW and NLR can be used as an independent parameter to assess risk of developing CAD. Many studies in the past have worked on either RDW or NLR alone; hence, in the present study, we have considered both RDW and NLR as an attempt to assess their correlation and also the utility of these parameters in risk scoring systems. MATERIALS AND METHODS This is a prospective study where blood from the patients diagnosed with ischaemic heart disease sent for haematological analysis was studied. A complete haemogram, ESR, and haematological analysis using a pure impedance fully automated 3part differential haematology analyser was done. 100 patients of ischaemic heart disease in whom haemoglobin levels were >11 gm/dL were included in the study. 50 non-ischaemic heart disease subjects with haemoglobin >11 gm/dL were selected as control group. RESULTS RDW was found to be high in patients with IHD (47.9±11.02) as compared to control group (41.3±6) with p=0.0001. NLR was also found to be high in patients with IHD (5.09±2.5) as compared to the control group (2.8±1.5) with p<0.0001. ESR was also high in patients (26±6.7) compared to control group (18±7) with p<0.0001. RDW was independent of ESR or NLR or any other risk factor of IHD. CONCLUSION RDW is independent of inflammatory markers and other risk factors in IHD. All the three can be included in the screening programs for IHD, if standardised. NLR appears to be superior to ESR as plasma factors don't play a role in their ratio.