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

Abstract

The systemic immune-inflammatory index (SII) and derived neutrophil-lymphocyte ratio (dNLR) are novel indexes that simultaneously reflect the host inflammatory and immune status and have prognostic value in some cancers. SII was associated with major cardiovascular events in coronary artery disease patients who received percutaneous coronary intervention (PCI). However, dNLR correlations with clinical outcomes in acute coronary syndrome (ACS) patients undergoing PCI remain unclear. This study aimed to elucidate the predictive values of SII and dNLR on the long-term prognosis of patients with ACS undergoing PCI. In total, 1,553 ACS patients undergoing PCI were consecutively enrolled from January 2016 to December 2018. The subjects were divided into high and low SII and dNLR groups for comparison (high vs. low). The SII and dNLR cutoff values for predicting major adverse cardiovascular events (MACE) were calculated using receiver operating characteristic curves, and Kaplan-Meier curves and Cox regression models were used for survival analyses. The endpoint was a MACE, which included all-cause mortality and rehospitalization for severe heart failure during follow-up. The Kaplan-Meier curves showed that a higher SII or dNLR value was associated with a higher risk of MACE (all P < 0.001). Multivariate Cox regression models showed that SII (hazard ratio [HR]: 2.545; 95% confidence interval [CI]: 1.416-4.574; P = 0.002) and dNLR (HR: 2.610, 95% CI: 1.454-4.685, P = 0.001) were independent predictors for MACE. dNLR may be a suitable laboratory marker to identify high-risk ACS patients after PCI.

Prognostic Impact of Multiple Lymphocyte-Based Inflammatory Indices in Acute Coronary Syndrome Patients

“…Monocyte may be more closely related to the development of atherosclerosis than platelet. SII was shown to be positively correlated with SYNTAX score ( 35 , 36 ), which could be used for CAD risk stratification and prognostic prediction after PCI. Jin and colleagues found that the high rates of stroke and all-cause death corresponded to high levels of SII and SIRI, while the high risk of MI was only independently related to high SIRI ( 15 ).…”

NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit

“…The NLR has been studied as a marker of severity and prognostication due to its ability to identify states of extreme physiological stress. Its use has been extensive in different diseases and conditions, including rheumatic diseases 13 , 22 , acute pulmonary embolism 21 , 26 , acute coronary syndrome 14 , 20 and acute pancreatitis 27 . The use of NLR in predicting the severity of community-acquired pneumonia (CAP) has been intensively studied 28 .…”

The Prognostic Value of Hematologic Inflammatory Markers in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

“…Previously, we described the SII, dNLR, NLR, PLR, and MLR as suitable laboratory markers for identifying high-risk ACS patients after PCI. 10 , 11 In recent years, new systemic inflammation markers, such as AISI, SIRI, and NLPR, have attracted the attention of many researchers because they include multiple components of CBC and are also easy to obtain. Monocytes and neutrophils are part of the innate immune system and produce pro-inflammatory mediators.…”

“… 9 Recently published studies have demonstrated that many combined ratios of CBC parameters, such as systemic immune-inflammatory index (SII), derived neutrophil-to-lymphocyte ratio (dNLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), could be useful prognostic markers in ACS patients undergoing PCI. 10 , 11 Furthermore, as more complicated and newly mentioned inflammatory markers, the aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), and neutrophil-to-lymphocyte*platelet ratio (NLRP) have only been proposed simultaneously as biomarkers for predicting mortality in COVID-19 patients. 9 , 12 , 13 However, no studies have investigated the prognostic capacity of these 3 novel indices for ACS prognosis.…”