Role of Neutrophil to Lymphocyte Ratio as a Predictor in Risk Stratifying Patients With Nste-Acs

Abstract

Background: Acute myocardial infarction is known to be accompanied by elevated leukocyte count. The differentiation of leukocyte types gives an added benefit of judging the severity of A.C.S. & predicting its clinical outcomes. Collecting peripheral blood samples is an easy & inexpensive test.Aim: To test the significance of Neutrophil to Lymphocyte ratio in risk stratifying patients with acute coronary syndromes and its early outcomes.Methods: One hundred patients with UA and NSTEMI were prospectively evaluated at Ain Shams University Hospital (63% UA and 37% NSTEMI). The patients were followed-up for clinical outcomes for 48 hours in-hospital & for one month after discharge. Results:The median (IQR) NLR was 8.4 (5.3 to 9.7) in NSTEMI group versus 1.8 (1.2 to 2.8) in unstable angina group, NLR > 3.9 had a sensitivity of 100%, & specificity of 92% as a diagnostic value. The patients were categorized into three groups: low risk, intermediate risk, & high risk, according to TIMI score. In unstable angina patients, the quartiles of NLR in "low risk", "intermediate risk" and "high risk" groups were 3 (2.0, 4.3), 3.4 (2.4, 5.1) and 5.5 (3.4, 9.65). In NSTEMI patients, the quartiles of NLR in "low risk", "intermediate risk", and "high risk" groups were 5. 1 (3.1, 8.1), 5.2 (3.0, 9.0) and 6.5 (3.9, 11.7). Meaning that there is positive correlation, as NLR values were found to be significantly elevated in high-risk groups. Conclusion: NLR on presentation, is a powerful & independent predictor of cardiovascular outcomes in patients with NSTE-ACS. It represents a good marker for stratifying patients with NSTE-ACS. It appears to have the chance of revitalization as a practical biomarkerwith high clinical predictability and prognostication. The easiness and swiftness of doing this test make it simple, cheap, and flawless early predictor for risk stratification in patients with NSTE-ACS.