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Updated: Dec 27, 2025
Flow Cytometry-Based Quantification and Analysis of Myocardial B-Cells
Published on: August 17, 2022
White blood cell subtypes as predictors of adverse cardiac events
Gisela A Kristono1,2, Ana S Holley1,2, Scott A Harding2,3
1Department of Surgery and Anaesthesia, University of Otago Wellington.
Insights
White blood cell ratios like neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) showed initial promise for predicting major adverse cardiovascular events (MACE) in acute myocardial infarction (AMI) patients. However, these ratios were not independently predictive in multivariate analysis.
Area of Science:
- Cardiology
- Hematology
- Biomarkers
Background:
- White blood cell (WBC) subtypes are linked to major adverse cardiovascular events (MACE) in acute myocardial infarction (AMI).
- Neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) have emerged as potential predictors of MACE.
- Investigating the prognostic value of specific WBC subtypes and their ratios in AMI is crucial.
Purpose of the Study:
- To confirm the association between MACE and WBC subtypes (neutrophils, lymphocytes, monocytes).
- To evaluate the predictive capability of neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) for MACE in AMI patients.
- To determine if NLR and LMR retain prognostic significance in a multivariate model.
Main Methods:
- A cohort of 860 acute myocardial infarction (AMI) patients was analyzed.
- White blood cell (WBC) subtype levels were collected from initial blood tests before angiography.
- One-year outcomes, including major adverse cardiovascular events (MACE), and baseline demographics were recorded.
Main Results:
- 15.1% of patients experienced MACE within one year.
- Univariate analysis revealed significant associations between MACE and both NLR (P=0.006) and LMR (P=0.005).
- In multivariate analysis, neither NLR nor LMR showed significant association with MACE after adjusting for clinical factors (P > 0.05).
Conclusions:
- NLR and LMR were not independently predictive of MACE in AMI patients when considered alongside other clinical variables.
- The prognostic value of NLR and LMR alone is limited for clinical application in AMI.
- Further research is needed to explore the utility of these ratios in conjunction with other inflammatory markers for MACE prediction.
Background:
White blood cell (WBC) subtypes have been associated with major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI). More recently, combining neutrophil and lymphocyte counts or lymphocyte and monocyte counts into a ratio has found to be promising for predicting MACE. This study aimed to confirm the association between MACE and the following WBC subtypes: neutrophils, lymphocytes, monocytes, neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR).
Methods:
In a cohort of 860 AMI patients, we collected levels of WBC subtypes from the earliest blood tests recorded prior to angiography. Data on baseline demographics and one-year outcomes were also collected.
Results:
At one year, 130 patients (15.1%) developed MACE. NLR and LMR were significantly associated with MACE on univariate analysis (P = 0.006 and 0.005, respectively). However, when combined into a multivariate model with age, hypertension, prior myocardial infarction and Type 2 diabetes, neither NLR nor LMR had significant associations (odds ratio = 1.058 and 0.966, P = 0.069 and 0.612, respectively).
Conclusion:
As NLR and LMR were correlated with MACE only on univariate analysis, we do not believe that they are predictive enough to be used alone in a clinical setting. Further studies are required to assess the prognostic ability of these ratios in combination with other inflammatory markers.
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