The neutrophil/lymphocyte ratio (NLR) has recently been described as a predictor of
mortality in patients who undergo percutaneous coronary intervention. The aim of this
study was to investigate the utility of admission NLRs in predicting outcomes in patients
with acute coronary syndromes (ACS). A total of 2,833 patients admitted to the University
of Michigan Health System with diagnoses of ACS from December 1998 to October 2004
were followed. Patients were divided into tertiles according to NLR. The primary end
point was all-cause in-hospital and 6-month mortality. The ACS cohort comprised 564
patients with ST-segment elevation myocardial infarctions and 2,269 patients with
non–ST-segment elevation ACS. Patients in tertile 3 had higher in-hospital (8.5% vs
1.8%) and 6-month (11.5% vs 2.5%) mortality compared with those in tertile 1 (p <0.001).
After adjusting for Global Registry of Acute Coronary Events risk profile, patients
in the highest tertile were at an exaggerated risk for in-hospital (odds ratio 2.04,
p = 0.013) and 6-month (odds ratio 3.88, p <0.001) mortality. Admission NLR is an
independent predictor of in-hospital and 6-month mortality in patients with ACS. This
relatively inexpensive marker of inflammation can aid in the risk stratification and
prognosis of patients diagnosed with ACS.
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References
- Atherosclerosis—an inflammatory disease.N Engl J Med. 1999; 340: 115-126
- What have we learned about the biology of atherosclerosis?.Am J Cardiol. 2001; 88: 3J-6J
- Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials.Heart. 2003; 89: 1200-1204
- Preprocedural white blood cell count and death after percutaneous coronary intervention.Am Heart J. 2003; 146: 692-698
- Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study.Ann Epidemiol. 2005; 15: 266-271
- Leukocyte count as a predictor of cardiovascular events and mortality in postmenopausal women: the Women's Health Initiative Observational Study.Arch Intern Med. 2005; 165: 500-508
- Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic cardiovascular diseases in patients with type 2 diabetes mellitus.Diabetes Metab Res Rev. 2007; 23: 111-118
- Which white blood cell subtypes predict increased cardiovascular risk?.J Am Coll Cardiol. 2005; 45: 1638-1643
- Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer.J Surg Oncol. 2005; 91: 181-184
- Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention.Am J Cardiol. 2006; 97: 993-996
- Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes.Am Heart J. 2001; 141: 190-199
- Predictors of hospital mortality in the global registry of acute coronary events.Arch Intern Med. 2003; 163: 2345-2353
- A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry.JAMA. 2004; 291: 2727-2733
- TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS.Eur Heart J. 2005; 26: 865-872
- Effect of elevated leukocyte count on in-hospital mortality following acute myocardial infarction.Am J Cardiol. 1996; 78: 945-948
- Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE).Am Heart J. 2004; 147: 42-48
- Association of peripheral neutrophilia with adverse angiographic outcomes in ST-elevation myocardial infarction.Am J Cardiol. 2004; 93: 532-536
- Neutrophil count and infarct size in patients with acute myocardial infarction.Int J Cardiol. 2004; 97: 155-156
- Prognostic value of neutrophil response in the era of acute myocardial infarction mechanical reperfusion.Rev Port Cardiol. 2004; 23: 1387-1396
- Role of neutrophils in myocardial ischemia and reperfusion.Circulation. 1995; 91: 1872-1885
- Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes.Circulation. 2003; 108: 1440-1445
- Neutrophil function in ischemic heart disease.Circulation. 1989; 79: 549-556
- Study of leukocytic hydrolytic enzymes in patients with acute stage of coronary heart disease.Indian J Med Sci. 2007; 61: 73-82
- Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease.Am J Cardiol. 1997; 79: 812-814
- Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction.Ann Intern Med. 1995; 122: 335-341
- Levels of T-lymphocyte subpopulations, interleukin-1β, and soluble interleukin-2 receptor in acute myocardial infarction.Am Heart J. 1994; 127: 1226-1230
- Altered status of CD4+CD25+ regulatory T cells in patients with acute coronary syndromes.Eur Heart J. 2006; 27: 2530-2537
- Lymphocyte responses in acute coronary syndromes: lack of regulation spawns deviant behaviour.Eur Heart J. 2006; 27: 2485-2486
- Pathophysiological role of oxidized low-density lipoprotein in plaque instability in coronary artery diseases.J Diabetes Complications. 2002; 16: 60-64
- Elevated levels of oxidized low density lipoprotein show a positive relationship with the severity of acute coronary syndromes.Circulation. 2001; 103: 1955-1960
Article Info
Publication History
Published online: July 01, 2008
Accepted:
May 1,
2008
Received in revised form:
May 1,
2008
Received:
March 21,
2008
Footnotes
This study was supported in part by unrestricted grants from Sanofi-Aventis, Bridgewater, New Jersey; the Edward and Helen Mardigian Foundation, Detroit, Michigan; and the University of Michigan Health System, Ann Arbor, Michigan.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
