Correlation of Neutrophil to Lymphocyte Ratio with in Hospital Mortality in Patients of Acute Coronary Syndrome

Authors

  • Ismail Ahmed Khan Department of Adult Cardiology, Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, Pakistan/ National University of Medical Sciences (NUMS) Pakistan
  • Syed Khurram Shahzad Department of Adult Cardiology, Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, Pakistan/ National University of Medical Sciences (NUMS) Pakistan
  • Azhar Ali Chaudhry Department of Adult Cardiology, Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, Pakistan/ National University of Medical Sciences (NUMS) Pakistan
  • Sheharbano Ahmed Khan Pak Emirates Military Hospital Rawalpindi Pakistan / National University of Medical Sciences (NUMS) Rawalpindi,Pakistan
  • Zohair Aziz Department of Adult Cardiology, Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, Pakistan/ National University of Medical Sciences (NUMS) Pakistan
  • Sadaf Shabbir Kiani Department of Cardiology, Armed Forces Institute of Cardiology / National Institute of Heart Diseases Rawalpindi Pakistan/ National University of Medical Sciences (NUMS) Pakistan
  • Fahad Khan Toru Department of Adult Cardiology, Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, Pakistan/ National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74iSUPPL-1.10495

Keywords:

Acute coronary syndrome, In-hospital Mortality, Neutrophil to lymphocyte ratio

Abstract

Objective: To study the correlation of Neutrophil to Lymphocyte Ratio (NLR) with in-hospital mortality in patients of Acute Coronary Syndrome (ACS).

Study Design: Analytical Cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan, from Jul-Dec 2022.

Methodology: One hundred and sixty patients regardless of gender and presented with ACS were included in this study. Their venous blood samples were taken, at the time of admission and were analyzed by the CBC analyzer (Mandray BC 6200) at pathology laboratory and who were delineated into high NLR (>5.25) and low NLR (≤5.25) groups. Their in-hospital morbidity and mortality outcomes were noted. Chi-squared test was applied to compare qualitative variables. Independent samples t-test was applied to compare mean values. Receiver Operating Characteristic (ROC) curve of NLR for predicting in-hospital mortality was plotted, and p-value of <0.05 was considered as statistically significant.

Results: Out of n=160 patients, 88(55.0%) were in low NLR group, while 72(45.0%) were in high NLR group. In-hospital mortality was statistically higher in the high NLR group 17(23.6%) vs low NLR group, 3(3.4%), p<0.001). The area under the ROC curve of NLR for predicting in-hospital mortality was 0.75(0.64-0.84). The best cut-off value of NLR to predict in-hospital mortality was 6.70(72.9% sensitivity, 70% specificity)

Conclusion: Patients in high NLR group have statistically higher in-hospital mortality. NLR is a sensitive and specific predictor of in-hospital mortality. Patients in the high NLR group also had lower mean EF, and higher mean troponin levels.

Downloads

Download data is not yet available.

References

Ralapanawa, U., Sivakanesan, R. (2021). Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review. Journal of epidemiology and global health, 11(2), 169–177. https://doi.org/10.299201217.001

Singh A, Museedi AS, Grossman SA. Acute Coronary Syn-drome. [Updated 2021 Jul 19]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

White PD, Mallory GK, Salcedo-Salgar J. The speed of healing of myocardial infarcts. Trans Am Clin Climatol Assoc. 1936; 52:97–104101. https://doi.org/10.1016%2Fs0002-8703(39)90845-8

Separham A, Abbaszadeh M, Sakha H, Sarvestani AH. Evaluation of the relation between monocyte count and angio-graphic thrombosis burden in patients with myocardial in-farction with STEMI under PPCI treatment. Journal of Research in Clinical Medicine. 2020 Oct 7; 8(1):41-.

https://doi.org/10.34172/jrcm.2020.041

Wang Z, Liu N, Ren L, Lei L, Ye H, Peng J, et al. Association of monocyte count on dmission with the angiographic thrombus burden in patients with st-segment elevation myocardial in-farc-tion undergoing primary percutaneous coronary intervention. Arquivos brasileiros de cardiologia. 2018 Apr; 110(4): 333-8. https://doi.org/10.5935/abc.20180034

Tian C, Song J, He D, Wu J, Sun Z, Sun Z, et al. Predictive value of mean platelet volume/platelet count for prognosis in acute myocardial infarction. International heart journal. 2018:17-212. https://doi.org/10.1536/ihj.17-212

Boyle JJ. Association of coronary plaque rupture and athe-rosclerotic inflammation. J Pathol. 1997; 181: 93–99.

https://doi.org/10.1002/(SICI)1096-9896(199701)181: 1%3C93::AID-PATH696%3E3.0.CO;2-H

Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardio-vascular risk? Journal of the American college of cardiology. 2005 May 17; 45(10): 1638-43.

Núñez J, Núñez E, Bodí V, Sanchis J, Miñana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. The American journal of cardiology. 2008 Mar 15; 101(6): 747-52. https://doi.org/10.1016/j.amjcard.2007.11.004

Avci BŞ, Avci A, Dönmez Y, Kaya A, Gülen M, Özer Aİ, et al. The effectiveness of neutrophil-lymphocyte ratio in predicting in-hospital mortality in non-ST-elevation myocardial infarction. Emergency medicine international. 2020 Mar 9;2020.

https://doi.org/10.1155/2020/8718304

Bajari R, Tak S. Predictive prognostic value of neutrophil–lymphocytes ratio in acute coronary syndrome. Indian Heart Journal. 2017 Apr 1; 69: S46-50.

https://doi.org/10.1016/j.ihj.2017.01.020

Singh A, Museedi AS, Grossman SA. Acute Coronary Syn-drome. [Updated 2022 Jul 11]. In: StatPearls. Treasure Island (FL): StatPearls 2022

Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M, et al. What is the normal value of the neutrophil-to-lym-phocyte ratio? BMC Res Notes. 2017 Jan 3; 10(1): 12.

https://doi.org/10.1186/s13104-016-2335-5

Yao, H., Ekou, A, Hounhoui Gan, S., Kouamé, M., Ehouman, E., Zeller, M., et al. Acute coronary syndromes in sub-Saharan Africa: A ten-year systematic review. Journal of the American Heart Association. 2022; 11: e021107.

https://doi.org/10.1161/JAHA.120.021107

American Heart Association. Heart disease and stroke statistics: 2006 update. http://circ. AHA Journals.

Fanta, K., Daba, F.B., Tegene, E. et al. Management quality indicators and in-hospital mortality among acute coronary syn-drome patients admitted to tertiary hospitals in Ethiopia: pro-spective observational study. BMC Emerg Med 21, 41 (2021). https://doi.org/10.1186/s12873-021-00433-3

Khan S, Razaq HU, Khan A. In-Hospital Mortality among Patients with Acute Coronary Syndrome With High Neutrophil To Lymphocyte Ratio. J Ayub Med Coll Abbottabad. 2021 Oct-Dec;3: 1(4): 791-795.

Ghaffari S, Nadiri M, Pourafkari L, Sepehrvand N, Movasagpoor A, Rahmatvand N, et al. The predictive value of total neutrophil count and neutrophil/lymphocyte ratio in predicting in-hospital mortality and complications after STEMI. Journal of cardiovascular and thoracic research. 2014; 6(1): 35. https://doi.org/10.5681%2Fjcvtr.2014.007

Li S, Chen H, Zhou L, Cui H, Liang S, Li H, et al. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion severity and long-term cardiovascular mortality in patients with unstable angina pectoris. Acute Cardiologic a. 2022 Sep 14; 77(8): 708-15.

https://doi.org/10.1080/00015385.2021.1963564

Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clinical biochemistry. 2018 Feb 1; 52: 131-6.

https://doi.org/10.1016/j.clinbiochem.2017.11.008

Downloads

Published

30-05-2024

Issue

Section

Original Articles

How to Cite

1.
Khan IA, Shahzad SK, Chaudhry AA, Khan SA, Aziz Z, Kiani SS, et al. Correlation of Neutrophil to Lymphocyte Ratio with in Hospital Mortality in Patients of Acute Coronary Syndrome. Pak Armed Forces Med J [Internet]. 2024 May 30 [cited 2024 Dec. 20];74(SUPPL-1):S6-S11. Available from: https://pafmj.org/PAFMJ/article/view/10495