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Exploring the diagnostic and prognostic value of the C-reactive protein/lymphocyte ratio for dilated cardiomyopathy
Bin Qi1,2,3, Zhi-Jie Yang1,2,3, Nan Huang1,2,3
1Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.
Insights
This study identifies key risk factors for dilated cardiomyopathy (DCM) and develops a model to predict heart failure (HF). The C-reactive protein/lymphocyte ratio (CLR) emerged as a significant predictor of cardiac decline and mortality in DCM patients.
Area of Science:
- Cardiology
- Biomarkers
- Predictive Modeling
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure (HF).
- Identifying risk factors and predictive models for HF in DCM patients is crucial for clinical management.
- Previous studies have explored various biomarkers, but a comprehensive risk model is still needed.
Purpose of the Study:
- To identify risk factors for DCM.
- To develop a predictive model for HF in DCM patients.
- To evaluate the diagnostic and prognostic value of specific inflammatory markers.
Main Methods:
- A cohort of 913 DCM patients was analyzed.
- Propensity score matching (PSM) was used to balance patient groups.
- Unconditional logistic regression, ROC curve analysis, and nomogram construction were employed.
- Kaplan-Meier survival analysis assessed mortality risk.
Main Results:
- Factors including sex, white blood cell count (WBC), neutrophils, platelet/lymphocyte ratio (PLR), and CRP/lymphocyte ratio (CLR) predicted worsening cardiac function.
- CLR demonstrated superior diagnostic efficacy (85.6% AUC) compared to NLR (77.0%) and PLR (76.6%).
- Higher CLR levels were associated with increased mortality risk, particularly in females.
Conclusions:
- The CRP/lymphocyte ratio (CLR) is a potent predictor of cardiac function decline and mortality in DCM patients.
- A nomogram incorporating sex, WBC, neutrophils, PLR, and CLR can aid in predicting HF risk.
- Further investigation is warranted to elucidate the precise mechanisms underlying the association between CLR and mortality in DCM.
Abstract:
To determine the risk factors for dilated cardiomyopathy (DCM) and construct a risk model for predicting HF in patients with DCM, We enrolled a total of 2122 patients, excluding those who did not meet the requirements. A total of 913 patients were included in the analysis (611 males and 302 females) from October 2012 to May 2020, and data on demographic characteristics, blood biochemical markers, and cardiac ultrasound results were collected. Patients were strictly screened for DCM based on the diagnostic criteria. First, these patients were evaluated using propensity score matching (PSM). Next, unconditional logistic regression was used to assess HF risk. Furthermore, receiver operating characteristic (ROC) curve analysis was conducted to determine diagnostic efficiency, and a nomogram was developed to predict HF. Finally, the Kaplan‒Meier survival curve was plotted. Of the initial 2122 patients, the ejection fraction (EF) in males was worse. We included 913 patients after the final DCM diagnosis. The results showed that the levels of NT-proBNP, WBC, PLT, neutrophils, lymphocytes, eosinophils, and IL-6, C-reactive protein (CRP) and the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and CRP/lymphocyte ratio (CLR) were higher in males than in females (P < 0.001-0.009). The nomogram showed that factors such as sex, WBC, neutrophils, PLR, and CLR could predict the risk of worsening cardiac function in patients with DCM before and after PSM (P < 0.05). The ROC curve showed that CLR with an 85.6% area demonstrated higher diagnostic efficacy than the NLR (77.0%) and PLR (76.6%, P < 0.05). Survival analysis showed a higher mortality risk in females with higher CLR levels (P < 0.001-0.009). However, high CLR levels indicated a higher mortality risk (P < 0.001) compared to sex. Male EF is lower in DCM patients. CLR could predict the risk of declined cardiac function in patients with DCM. The mortality in females with higher CLR levels was highest; however, the exact mechanism should be investigated.
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