Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting Adverse Events in Elderly Patients With Chronic Heart Failure

Yan, Wei; Li, Ruijun; Mu, Yang; Jia, Qi; He, Kunlun

doi:10.1536/ihj.16-049

Cited by 34 publications

(29 citation statements)

References 31 publications

(33 reference statements)

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“…In elderly patients with CHF, NLR was independently correlated with the occurrence of major cardiovascular events (MCE), as well as with CKD [34]. During a median follow-up period of 18 months, those with the highest tertile of the NLR (median 4.1, interquartile range 3.39 to 6.01) had a significantly higher incidence of cardiac death and rehospitalization for heart failure [34].…”

Section: Heart Failure In Elderly Patientsmentioning

confidence: 99%

The neutrophil to lymphocyte ratio in heart failure: a comprehensive review

Delcea

Buzea

Dan

2019

Romanian Journal of Internal Medicine

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Introduction. Heart failure (HF) and systemic inflammation are interdependent processes that continuously potentiate each other. Distinct pathophysiological pathways are activated, resulting in increased neutrophil count and reduced lymphocyte numbers, making the neutrophil to lymphocyte ratio (NLR) a potential indirect marker of severity. We conducted this comprehensive review to characterize the role of NLR in HF. Methods. We searched the PubMed (MEDLINE) database using the key words “neutrophil”, “lymphocyte”, “heart failure”, “cardiomyopathy”, “implantable cardioverter defibrillator”, “cardiac resynchronization therapy” and “heart transplant”. Results. We identified 241 publications. 31 were selected for this review, including 12,107 patients. NLR was correlated to HF severity expressed by clinical, biological, and imaging parameters, as well as to short and long-term prognosis. Most studies reported its survival predictive value. Elevated NLR (>2.1–7.6) was an independent predictor of in-hospital mortality [adjusted HR 1.13 (95% CI 1.01–1.27) – 2.8 (95% CI 1.43–5.53)] as well as long-term all-cause mortality [adjusted HR 1.43 (95% CI 1.1–1.85) – 2.403 (95% CI 1.076–5.704)]. Higher NLR levels also predicted poor functional capacity [NLR > 2.26/2.74, HR 3.93 (95% CI 1.02–15.12) / 3.085 (95% CI 1.52–6.26)], hospital readmissions [NLR > 2.9/7.6, HR 1.46 (95% CI 1.10–1.93) / 3.46 (95% CI 2.11–5.68)] cardiac resynchronization therapy efficacy [NLR > 3.45/unit increase, HR 12.22 (95% CI 2.16–69.05) / 1.51 (95% CI 1.01–2.24)] and appropriate implantable cardioverter defibrillator shocks (NLR > 2.93), as well as mortality after left ventricular assist device implantation [NLR > 4.4 / quartiles, HR 1.67 (95% CI 1.03–2.70) / 1.22 (95% CI 1.01–1.47)] or heart transplant (NLR > 2.41, HR 3.403 (95% CI 1.04–11.14)]. Conclusion. Increased NLR in HF patients can be a valuable auxiliary biomarker of severity, and most of all, of poor prognosis.

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Section: Heart Failure In Elderly Patientsmentioning

confidence: 99%

The neutrophil to lymphocyte ratio in heart failure: a comprehensive review

Delcea

Buzea

Dan

2019

Romanian Journal of Internal Medicine

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“…It is now established that certain molecules combined chronic inflammatory process and underlying endothelial dysfunction play important role in development of insulin resistance, diabetes and associated complications [12,13]. Neutrophilia or lymphopeniais associated with high NLR while lymphocytosis or neutropenia with low NLR [14]. Literature suggest that neutrophilia and relative lymphocytopeniaare independent markers for diabetic neuropathy including neuropathy [15,16].…”

Section: Discussionmentioning

confidence: 99%

Association between Diabetic Neuropathy and Neutrophil Lymphocyte Ratio amongst Type 2 Diabetics

Wadhwani¹,

Chittawar²,

Gedam³

et al. 2020

SJAMS

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Original Research Article Background: The study aimed to evaluate the relationship between Diabetic neuropathy and neutrophil lymphocyte ratio amongst patients with type 2 diabetes. Methodology: The study was conducted as a cross sectional study in outpatient Department of Medicine, Hamidia Hospital Bhopal for a period of 6 months. All the 100 known cases of type 2 diabetes belonging to age group of 18 to 80 years and giving consent were included in the study. Detailed data regarding sociodemographic variables, diabetes duration and treatment was obtained and entered in questionnaire. Height, weight, BMI was recorded. CBC, FBS, PPBS and HbA1c was also conducted. Results: The present study observed no statistically significant association between various baseline variables and Neutrophil to lymphocyte ratio (p>0.05).Neutrophil to lymphocyte ratio were significantly associated with duration of diabetes and presence of neuropathy i.e. NLR were significantly higher in patients with neuropathy and patients with longer duration of diabetes (p<0.05). Diabetic neuropathy was observed to be significantly correlated with neutrophil to lymphocyte ratio and duration of diabetes (p<0.01). Conclusion: Higher neutrophil to lymphocyte ratio may be considered as a prognostic indicator of diabetic neuropathy. This is a cost effective marker that is easily available and can be used in community settings as well as resource poor settings.

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“…NLR is not affected by the acute inflammation of the whole body; unlike the absolute value of simple neutrophils, it is a more stable indicator of systemic inflammation and a prognostic marker in patients with cancer, coronary artery disease, heat failure, TIA, and calcification aortic valve disease. [29][30][31] The NLR is more stable than the pure white blood cell count, which is not easily disturbed by the other factors in the blood samples, and has a more predictive value. In 2013, Bilen, et al found that BAV is associated with elevated mean platelet volume (MPV).…”

Section: Discussionmentioning

confidence: 99%

Predictive Roles of Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Calcific Aortic Valve Disease

Song

Zheng

et al. 2019

Int. Heart J.

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The neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) are emerging indirect blood markers to roughly reflect the inflammation level in our body while some pathological changes occurring in aortic valve tissue. Few recent studies demonstrated that NLR is related to calcific aortic valve disease (CAVD). However, the extent of the relationship between them and the impact of CRP on CAVD are not clear. This study aimed to investigate the diagnostic influence and surgical predictive effect of NLR and CRP on CAVD. A total of 278 consecutive patients with CAVD (123 patients with bicuspid aortic valve and others with tricuspid aortic valve) and 108 healthy individuals who were included in the control group were enrolled in the study. The NLR was calculated from the complete blood count, and the CRP was measured from peripheral blood samples. Echocardiography was used to evaluate the severity of aortic stenosis. Intraoperation/postoperation indicators were collected in 166 patients from the total consecutive patients who underwent aortic valve replacement (AVR) alone. Significantly higher NLR was measured in both the BAV group (1.96 ± 0.78 versus 0.97 ± 0.15, P < 0.001) and the TAV group (2.51 ± 2.03 versus 0.97 ± 0.15, P < 0.001) compared with the control group. Moreover, the NLR level was significantly higher (P < 0.001) and the CRP level was significantly lower (P = 0.007) of the TAV group than that of the BAV group; a significant positive correlation between the NLR and the maximum gradient of aortic valve was detected. Furthermore, there was a moderate correlation between the NLR and the postoperative mechanical ventilation time. Our results indicated that the NLR and CRP were novel and useful predictive factors in patients with CAVD, and these two potential factors have guiding significance for the prediction of different pathological typing (BAV or TAV). Higher NLR level will not extend the cardiopulmonary bypass time (CPB); however, it will prolong the operation time and the postoperative mechanical ventilation time.

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Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting Adverse Events in Elderly Patients With Chronic Heart Failure

Cited by 34 publications

References 31 publications

The neutrophil to lymphocyte ratio in heart failure: a comprehensive review

The neutrophil to lymphocyte ratio in heart failure: a comprehensive review

Association between Diabetic Neuropathy and Neutrophil Lymphocyte Ratio amongst Type 2 Diabetics

Predictive Roles of Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Calcific Aortic Valve Disease

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