The Neutrophil-to-Lymphocyte Ratio Is an Important Indicator Predicting In-Hospital Death in AMI Patients

Abstract

Objective: To explore the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the short-term prognosis of NSTEMI and STEMI.Methods: This study was a single-center, retrospective and observational study. 2618 patients including 1289 NSTMI and 1329 STEMI patients were enrolled from June 2013 to February 2018 in Zhongda Hospital, Southeast University. The demographic information, clinical characteristics, medical history, laboratory examination, treatment, and outcome of individuals at admission and during hospitalization were extracted from the electronic medical record system. Outcome was defined as the all-cause death during hospitalization.Results: (1) In the NSTEMI group, the ability of NLR in predicting in-hospital death (AUC = 0.746) was higher than the neutrophil-monocyte ratio (NMR) (AUC = 0.654), the platelet-lymphocyte ratio (PLR) (AUC = 0.603) and the lymphocyte-monocyte ratio (LMR) (AUC = 0.685), and also higher than AST (AUC = 0.621), CK (AUC = 0.595), LDH (AUC = 0.653) and TnI (AUC = 0.594). The AUC of NLR in the STEMI group was only 0.621. (2) The optimal cut-off value of NLR in NSTEMI group was 5.509 (Youden index = 0.447, sensitivity = 77.01%, specificity = 67.72%). After adjusting variables including age, sex, diabetes history, smoking history, LDL-C and Cr, the logistic regression showed that the patients with NLR>5.509 had higher hazard risk of death (HR4.356; 95%CI 2.552–7.435; P < 0.001) than the patients with NLR ≤ 5.509. (3) Stratification analysis showed that the in-hospital mortality of patients with NLR > 5.509 was 14.611-fold higher than those with NLR ≤ 5.509 in patients aged <76, much higher than the ratio in patients aged ≥ 76. For patients with creatinine levels ≤ 71, the in-hospital death risk in high NLR group was 10.065-fold higher than in low NLR group (95%CI 1.761–57.514, P = 0.009), while the HR was only 4.117 in patients with creatinine levels > 71. The HR in patients with or without diabetes were 6.586 and 3.375, respectively. The HR in smoking or no smoking patients were 6.646 and 4.145, respectively. The HR in patients with LDL-C ≥ 2.06 or <2.06 were 5.526 and 2.967 respectively.Conclusion: Compared to NMR, PLR, and LMR, NLR had the best ability in predicting in-hospital death after NSTEMI. Age, creatinine, LDL-C, diabetes and smoking history were all important factors affecting the predictive efficiency in NSTEMI. NLR had the limited predictive ability in STEMI.

Routine laboratory parameters, including complete blood count, predict COVID-19 in-hospital mortality in geriatric patients

“…In COVID-19 patients, neutrophilia associated with lymphopenia was observed in patients with increased disease severity and with poor prognosis ( Picchi et al, 2021 , Yang et al, 2020 , Zhu et al, 2021 ). A number of studies showed a correlation between markers derived from standard blood count tests, such as neutrophil-to-lymphocyte ratio (NLR), derived NLR ratio (dNLR, neutrophil count divided by the result of WBC count minus neutrophil count), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) and systematic inflammatory response in a number of age-related diseases, including cancer ( Xu et al, 2021 , Ying et al, 2014 ), type 2 diabetes mellitus (T2DM) ( Tong et al, 2004 ), cardiovascular diseases (CVD) ( Bhat et al, 2013 , Ji et al, 2021 ), and stroke ( Cai et al, 2021a ).…”

The Core Role of Neutrophil–Lymphocyte Ratio to Predict All-Cause and Cardiovascular Mortality: A Research of the 2005–2014 National Health and Nutrition Examination Survey

“…After the adjustment of the variable, the above conclusion still holds. Unlike the previous study on this topic ( 21 – 24 ), our research further clarified the exact relationship between NLR and two types of mortality, and we also identified the valuable threshold points. Besides, we constructed a prognostic-related nomogram model for the first time.…”

“…After that, neutrophils will release cytokines, which also affect the activation of lymphocytes, and participate in inflammation. Inflammatory cytokines released by neutrophils accelerate the progression of CVDs ( 24 ). Therefore, many CVDs, such as coronary atherosclerotic heart disease and acute myocardial infarction, are considered to be the result of inflammation ( 26 ).…”

Impact of lactate dehydrogenase on prognosis of patients undergoing cardiac surgery

“…Inflammation might be additional possible explanation for the association between increased LDH level and adverse prognosis in patients after cardiac surgery. Accumulating evidence revealed that inflammatory biomarkers, such as NLR [ 34 , 35 ] and CRP [ 36 ], have been reported to be correlated with adverse outcomes of CHD or acute myocardial infarction. There is a paucity of reports about the prognostic effect of inflammatory markers in valve disease.…”