Role of circulatory leukocyte based indices in short-term mortality of patients with heart failure with reduced ejection fraction

Abstract

Background. Pro-inflammatory signaling is mediated by a variety of inflammatory mediators which can cause myocardial apoptosis, hypertrophia, and fibrosis, and also ultimately lead to adverse cardiac remodeling. This study aimed to assess the role of circulating leukocyte-based indices in predicting the short-term mortality in patients with heart failure with reduced ejection fraction (HFrEF).
 Methods. In a retrospective study, patients with HFrEF admitted to a tertiary referral center between January 2016 and January 2017 were recruited to this study. The association between neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dLNR = neutrophils/(leukocytes-neutrophils)), monocyte/granulocyte to lymphocyte ratio (MGLR = (white cell count-lymphocyte count) to lymphocyte count), platelet to lymphocyte ratio (PLR) and six-months mortality of patients were assessed.
 Results. A total of 197 patients with HFrEF were enrolled in the study. NLR (P<0.001), dNLR (P<0.001), MGLR (P<0.001), PLR (P=0.006) and LVEF (P=0.042) showed significant difference between survived and died patients. In the Cox multivariate analysis we did not find NLR, dLNR, MGLR or PLR as an independent predictor of short-term mortality in HFrEF patients.
 Conclusions. Although High NLR, PLR, MGLR and dNLR was associated with short-term mortality, it failed to independently predict the prognosis of HFrEF patients.

The Prognostic Value of a Derived Neutrophil-Lymphocyte Ratio in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

“…[14][15][16] Additionally, SII was associated with adverse outcomes in chronic heart failure and major cardiovascular events in CAD patients who received PCI, and dNLR was associated with short-term mortality in patients with heart failure. 14,17 However, dNLR correlations with clinical outcomes in ACS patients undergoing PCI remain unclear. Therefore, this study aimed to elucidate the predictive values of SII and dNLR on the long-term prognosis of ACS patients undergoing PCI.…”

Trends in the development of Medicine, Biology and Pharmacy

“…In a study on HF patients performed by Yan et al it was shown that high NLR is associated with a higher rate of major cardiovascular events in elderly patients with HF [333]. A multicenter study conducted by Delcea et al [333] confirmed that SNL correlates with disease severity and is a prognostic marker associated with an increased risk of mortality.…”

“…Activation of this link leads to the secretion of cortisol, and increased levels of cortisol lead to a decrease in the relative concentration of lymphocytes. Lymphopenia, found in patients with acute or chronic heart failure, regardless of etiology correlates with the severity of the disease and is a negative prognostic marker associated with increased mortality [333].…”

“…This indicator can be determined by dividing the number of neutrophils by the number of lymphocytes. NLR provides information on two pathophysiological pathways: neutrophils (associated with a rapid immune response and elevated levels of free radicals responsible for tissue damage) and lymphocytes (associated with a chronic adaptive immune response) [333].…”

“…Increased NLR levels indicate endothelial damage and dysfunction as a result of increased neutrophil secretory activity, which can lead to an unfavorable prognosis in CVD [335]. According to the literature, in modern cardiology, studies have shown that NLR is an independent predictor of outcome in patients with stable coronary heart disease and a predictor of short -and long-term mortality in patients with acute coronary syndromes ((ST-segment elevation myocardial infarction) (STEMI)) and heart transplantation [333]. In addition, NLR can also be used to risk stratification in patients with both CHF and acute HF decompensation.…”