Association between inflammatory hematological ratios and aortic valve stenosis: a propensity-matched analysis

Relationship between systemic inflammation and aortic valve stenosis (AVS) has been well demonstrated. This investigation aimed to evaluate the link between various inflammation hematological ratios and patients with AVS.

Patients with AVS (n = 229) and control (n = 1716) were identified. Propensity score matching (PSM) was performed with the proportion of 1:1 using logistic regression based on the variables of age, sex, hypertension, diabetes, creatinine (Cr) and glutamate transpeptidase (γ-GT). The receiver operating characteristic (ROC) analysis was used to estimate the performance of inflammation hematological ratios for distinguishing AVS. Univariate and multivariate analysis were performed to identify the independent risk factors of AVS. In addition, restricted cubic splines (RCS) regression analysis revealed the non-linear correlation between inflammation hematological ratios and AVS.

After PSM, 392 patients (196:196) were included. Univariate analysis showed monocyte/high density lipoprotein ratio (MHR) and neutrophil/lymphocyte ratio (NLR) were significantly higher in AVS group (MHR, 0.49 ± 0.23 vs 0.32 ± 0.20, p < 0.001, NLR, 3.52 ± 2.52 vs 2.87 ± 1.89, p < 0.001) while lymphocyte/monocyte ratio (LMR) was significantly lower (3.27 ± 1.72 vs 4.08 ± 1.76, p < 0.001). But the level of platelet/lymphocyte ratio (PLR) and systemic inflammation index (SII) (PLR, 146.27 ± 82.68 vs 143.27 ± 66.95, p = 0.927, SII, 690.22 ± 602.69 vs 610.58 ± 403.33, p = 0.100) did not differ significantly between the two groups. However, in multivariate logistic regression models, only MHR remained to be an independent risk factor of AVS (OR 2.010 with 95%CI 1.040-3.887, p = 0.038). Besides MHR, atrial fibrillation (AF), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and hemoglobin (Hgb) were also performed to be independent risk factors of AVS. ROC analysis showed that the cut-off value of MHR (0.2750) indicated AVS with 85.2% sensitivity and 51.5% specificity [95% confidence interval [CI] = 0.691-0.788, the area under the curve [AUC] = 0.740, P < 0.001]. Further, RCS revealed the non-linear correlation between MHR and AVS (p for non-linearity <0.001).

Elevated MHR was independently associated with the presence of AVS. MHR demonstrated stronger associational strength with AVS compared to other inflammatory hematological ratios such as SII, NLR, PLR and LMR.