Related Experiment Videos
Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial
Julio Núñez1, Eduardo Núñez, Vicent Bodí
1Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain. yulnunez@gmail.com
Insights
The neutrophil-to-lymphocyte ratio (N/L) maximum value effectively predicts mortality in ST-segment elevation myocardial infarction (STEMI) patients. This N/L ratio demonstrates superior predictive ability compared to total white blood cell count in STEMI risk stratification.
Area of Science:
- Cardiology
- Hematology
- Biomarkers
Background:
- Neutrophil-to-lymphocyte ratio (N/L) is linked to adverse outcomes in cardiac patients.
- Its prognostic value in ST-segment elevation myocardial infarction (STEMI) requires further clarification.
Purpose of the Study:
- To assess the association between maximum N/L ratio (N/L max) and mortality in STEMI patients.
- To compare the predictive performance of N/L max against maximum white blood cell count (WBC max).
Main Methods:
- Analysis of 470 STEMI patients with daily WBC and differential counts for 96 hours.
- Cox regression analysis to evaluate N/L max and WBC max in relation to mortality.
- Multivariable adjustment for standard cardiovascular risk factors.
Main Results:
- A significant trend of increased mortality with higher N/L max quintiles was observed (p <0.001).
- N/L max remained an independent predictor of mortality in multivariable analysis (HR 4.20 for Q5 vs Q1, p=0.001).
- The model incorporating N/L max exhibited superior discriminative ability compared to WBC max.
Conclusions:
- Maximum N/L ratio is a valuable and independent predictor of subsequent mortality in STEMI patients.
- N/L max offers enhanced prognostic capability over total WBC max for risk stratification in STEMI.
Abstract:
Neutrophil to lymphocyte ratio (N/L) has been associated with poor outcomes in patients who underwent cardiac angiography. Nevertheless, its role for risk stratification in acute coronary syndromes, specifically in patients with ST-segment elevation myocardial infarction (STEMI), has not been elucidated. We sought to determine the association of N/L maximum value (N/L max) with mortality in the setting of STEMI and to compare its predictive ability with total white blood cell maximum count (WBC max). We analyzed 515 consecutive patients admitted with STEMI to a single university center. White blood cells (WBC) and differential count were measured at admission and daily for the first 96 hours afterward. Patients with cancer, inflammatory diseases, or premature death were excluded, and 470 patients were included in the final analysis. The association between N/L max and WBC max with mortality was assessed by Cox regression analysis. During follow-up, we registered 106 deaths (22.6%). A positive trend between mortality and N/L max quintiles was observed; 6.4%, 12.4%, 11.7%, 34%, and 47.9% of deaths occurred from quintiles 1 to 5 (p <0.001), respectively. In a multivariable setting, after adjusting for standard risk factors, patients in the fourth (Q4 vs Q1) and fifth quintile (Q5 vs Q1) showed the highest mortality risk (hazard ratio 2.58, 95% confidence interal 1.06 to 6.32, p = 0.038 and hazard ratio 4.20, 95% confidence interal 1.73 to 10.21, p = 0.001, respectively). When WBC max and cells subtypes were entered together, N/L max remained as the only WBC parameter; furthermore, the model with N/L max showed the most discriminative ability. In conclusion, N/L max is a useful marker to predict subsequent mortality in patients admitted for STEMI, with a superior discriminative ability than total WBC max.