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Updated: Jan 8, 2026
Investigating Aortic Valve Calcification via Isolation and Culture of T Lymphocytes using Feeder Cells from Irradiated Buffy Coat
Published on: February 4, 2021
Associations between blood cell-based inflammatory indices and their changes and mortality in patients undergoing
Weiya Li1,2,3, Hongde Li1,2,3, Shiqin Peng1,2,3
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Insights
Post-transcatheter aortic valve replacement (TAVR) inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil percentage-to-albumin ratio (NPAR), predict mortality better than pre-TAVR values. NPAR is the most potent predictor for risk stratification.
Area of Science:
- Cardiovascular Medicine
- Inflammation and Immunology
- Medical Diagnostics
Background:
- Chronic inflammation drives cardiovascular diseases like valvular calcification.
- Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil percentage-to-albumin ratio (NPAR) are key systemic inflammation markers.
- Limited research exists on dynamic changes of these markers predicting outcomes post-transcatheter aortic valve replacement (TAVR).
Purpose of the Study:
- To evaluate the predictive value of pre- and post-TAVR inflammatory markers (NLR, PLR, NPAR) for all-cause mortality.
- To assess the impact of dynamic changes in these markers on mortality risk.
- To compare the predictive power of pre-TAVR versus post-TAVR inflammatory marker levels.
Main Methods:
- Retrospective single-center cohort (n=1629) and prospective multicenter cohort (n=443) studies.
- Stratification into tertiles based on pre- and post-TAVR NLR, PLR, and NPAR.
- Multivariate Cox regression, restricted cubic spline (RCS), and time-dependent ROC curve analyses were used.
Main Results:
- Higher tertiles of pre- and post-TAVR NLR, PLR, and NPAR were associated with increased all-cause mortality.
- Post-TAVR inflammatory markers showed greater predictive value for mortality than pre-TAVR values.
- An increase in post-TAVR markers from baseline significantly elevated mortality risk; findings were validated in the prospective cohort.
Conclusions:
- Post-TAVR NLR, PLR, and NPAR are superior predictors of mortality compared to pre-TAVR values, with NPAR being the most significant.
- These blood cell-based inflammatory markers enable precise risk stratification for TAVR patients.
- Further interventional studies targeting these markers, particularly NPAR, are recommended.
Background:
Chronic inflammation is a driver of cardiovascular diseases, including valvular calcification. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil percentage-to-albumin ratio (NPAR) are promising markers of systemic inflammation. However, research on the predictive value of dynamic changes in these indices for clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) remains limited.
Materials And Methods:
This study employed a retrospective single-center cohort (2012-2023, n = 1629) with validation in a prospective multicenter cohort (2023-2024, n = 443). The primary endpoint was all-cause mortality. All participants were stratified into tertiles based on pre- and post-TAVR values of NLR, PLR, and NPAR. Multivariate Cox proportional hazards regression models and restricted cubic spline (RCS) models were used to assess associations of pre-TAVR, post-TAVR, and dynamic changes in these three composite inflammatory markers with mortality. Receiver operating characteristic (ROC) curves and time-dependent Harrell's C-index were applied to evaluate the time-varying predictive value of these markers for mortality.
Results:
Multivariable-adjusted Cox regression models showed that the highest tertile of inflammatory markers (both pre- and post-TAVR) was associated with a higher risk of all-cause mortality than the lowest tertile (pre-TAVR: NLR, aHR = 1.61, P = 0.032; PLR, aHR = 1.88, P = 0.003; NPAR, aHR = 1.69, P = 0.027). Multivariable-adjusted Cox regression and ROC analysis showed that post-TAVR inflammatory markers demonstrated a greater predictive value for mortality than pre-TAVR values. Time-dependent Harrell's C-index analysis showed high and time-constant predictive values of the pre- and post-TAVR NLR, PLR, and NPAR for mortality. An increase in post-TAVR inflammatory markers from baseline was associated with a sharp rise in mortality risk. Replicate analyses in the multicenter prospective cohort validated the robustness of the findings from our single-center analysis.
Conclusions:
Post-TAVR NLR, PLR, and NPAR exhibit superior predictive value for mortality compared to pre-TAVR values, with NPAR being the most powerful predictor. Measurement of these three blood cell-based composite inflammatory markers enables precise risk stratification of TAVR patients. Further interventional studies targeting these markers, especially NPAR, are warranted.
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