Coronary artery disease
Usefulness of Neutrophil to Lymphocyte Ratio in Predicting Short- and Long-Term Mortality After Non–ST-Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2010.03.062Get rights and content

Neutrophil/lymphocyte ratio (NLR) is the strongest white blood cell predictor of adverse outcomes in stable and unstable coronary artery syndromes. The aim of our study was to explore the utility of NLR in predicting long-term mortality in patients with non–ST-segment elevation myocardial infarction (NSTEMI). Consecutive patients with NSTEMI at Staten Island University Hospital were evaluated for study inclusion. Of the 1,345 patients with NSTEMI admitted from September 2004 to September 2006, 619 qualified for study inclusion. Survival analysis, stratified by NLR tertiles, was used to evaluate the predictive value of average inpatient NLR levels. Four-year vital status was accessed with electronic medical records and Social Security Death Index. Patients in the highest NLR tertile (NLR >4.7) had a higher 4-year mortality rate (29.8% vs 8.4%) compared to those in the lowest tertile (NLR <3, Wilcoxon chi-square 34.64, p <0.0001). After controlling for Global Registry of Acute Coronary Events risk profile scores, average NLR level remained a significant predictor of inpatient and 4-year mortality. Hazard ratios per unit increase of average NLR (log) increased by 1.06 (p = 0.0133) and 1.09 (p = 0.0006), respectively. In conclusion, NLR is an independent predictor of short-term and long-term mortalities in patients with NSTEMI with an average NLR >4.7. We strongly suggest the use of NLR rather than other leukocyte parameters (e.g., total white blood cell count) in risk stratification of the NSTEMI population.

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Methods

This retrospective longitudinal observational study explored the predictive value of NLR on short- and long-term survival in 1,345 patients with NSTEMI discharged from Staten Island University Hospital (Staten Island, New York), the only angioplasty-providing tertiary center in Staten Island, with a semi-isolated population of 443,728 (77.6% white Americans), from September 2004 to September 2006. Study inclusion required a cardiologist-confirmed NSTEMI diagnosis with a documented gradual

Results

All-cause 4-year mortality was the primary outcome. Of the 619 patients with NSTEMI, 108 (17.3%) deaths occurred. Figure 2 illustrates significant higher in-hospital, 6-month, and 4-year mortalities (8.7%, 14.4%, and 29.8% respectively) in third-tertile patients compared to those in first tertile (1%, 3%, and 8.4% respectively, Mantel-Haenszel chi-square 32.69, p <0.0001). Four-year Kaplan-Meier curves indicate that patients in the highest average NLR tertile had significantly worse

Discussion

In our study, average NLR was a stronger independent predictor of short- and-long term survival than other leukocyte parameters. The predictive superiority of NLR may be due to 2 factors. First, common physiologic conditions (e.g., dehydration) and in vitro handling of blood specimens may affect the absolute number of individual subtypes of white blood cells more than NLR. For example, exercise and catecholamine increase neutrophil and lymphocyte counts,9, 10 affecting to a lesser degree the

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